CRITICAL FACTORS DETERMINING ACCESS TO ACUTE STROKE CARE

Objective: Our objective was to assess gender, ethnic, and access-to-c are factors critical in delay time (DT) for presentation to the hospit al for acute stroke. Background: Little information is available on th e effect of gender, ethnicity, and access issues on DT. Design: Demogr aphic, access-to-care, and DT information was obtained from emergency department (ED) documentation of stroke patients admitted from July 19 95 through June 1997 at Hermann Hospital, Houston, TX. Univariate and multivariate regression analyses were performed. Results: Of the 241 e ligible patients, 126 were African American (AA), 82 were non-Hispanic white (NHW), and 33 were Hispanic American (HA). Median DT from sympt om onset to presentation to the ED was 222 minutes for AAs, 280 minute s for HAs, and 230 minutes for NHWs. A multivariate regression model e stimated DT to ED arrival decreased with ambulance transport (p = 0.00 3) and increased in patients with a primary care physician (p = 0.145) and in women (p = 0.052). DT to see an ED physician after hospital ar rival decreased with ambulance transport (p < 0.001), hemorrhage patie nts (p = 0.006), and worse stroke severity (p = 0.038), and increased in women (p = 0.041). DT to see a neurologist decreased with hemorrhag e (p = 0.002) and ambulance arrival (p = 0.010). Neurologists saw pati ents within 3 hours of symptom onset in 34% of NHWs, 28% of AAs, and 1 8% of HAs. Conclusion: Gender and access-to-care issues may be importa nt determinants of delay in acute stroke care. Less than 20% of HAs pr esented to the ED within 3 hours of symptom onset.