Abstract MP058: Racial and Gender Differences in Acute Ischemic Stroke Pre-hospital Documentation: Last Known Well, Pre-alert Notification and Stroke Severity, Paul Coverdell National Acute Stroke Program, 2012-2015

Stroke is the fifth leading cause of death in the United States and a major cause of adult disability. Documentation of stroke-related factors that occur before arrival to the hospital or immediately upon arrival may be critical in determining patient eligibility for life-saving measures, including receipt of thrombolytic therapy (e.g., alteplase) and other neurointerventional treatment. There is a need to describe differences in documentation of pre-hospital measures, in order to improve overall stroke patient care. De-identified data for 216,129 stroke patients were reported by hospital personnel during the 2012-2015 Paul Coverdell National Acute Stroke Program. Chi-square tests were performed to examine the differences on demographic and pre-hospital measures by gender and race. The median age was greater for females than males (75 vs 68 years) and for whites than blacks (74 vs 63 years). A higher percentage of females had Medicare coverage than males (67.8% vs. 57.4%, p<0.001), while blacks had higher Medicaid coverage than whites (12.8% vs. 4.2%, p<0.0001). Females (49.9%) and blacks (48.8%) had the highest percentage of arrival by EMS. Among patients who arrived by emergency services, the percentage of blacks with advance notification of stroke was lower than whites (49.8% vs. 58.2%, p<0.0001). Females (53.0%) were slightly less likely to have last known well time recorded than males (53.8%). Blacks were significantly less likely to have last known well time and stroke severity recorded compared whites (p<0.0001). The median time interval between last known well and emergency department arrival for blacks were 4.8 hours, significantly longer than median time of 4.0 hours for whites (p<0.001). Differences in documentation of pre-hospital measures, particularly between racial groups, suggest room for improvement in communication of information from the pre-hospital environment to emergency department staff, which may support access to critical links in the chain of stroke survival, including activation of stroke care teams who can provide swift access to life-saving treatment.