Women at Greater Risk For Missed Acute Stroke Diagnosis in Prehospital Care

Women with acute stroke are less likely than men to be accurately identified as having a stroke in the prehospital setting, according to findings published in Stroke.

Researchers conducted a systematic review and meta-analysis to assess sex differences in prehospital management of patients with acute or suspected stroke. Eligible studies included those involving patients transported to the hospital by emergency medical services (EMS). The primary outcome was the relative risk (RR) of sex differences in accurate prehospital diagnoses. A random-effects model with inverse variance weighting was employed for statistical analysis.

A total of 16 studies, encompassing 622,764 women and 571,024 men (mean age range, 65-78 years) were included in the analysis. In 8 studies (women, n=38,233; men, n=39,556) examining sex differences in prehospital diagnosis of acute stroke, women were less likely than men to be correctly identified as having a suspected stroke (RR, 0.92; 95% CI, 0.89-0.96; P <.0001). A subgroup analysis of 4 studies (women, n=12,487; men, n=13,840) that only recruited patients with prehospital suspected stroke found a similar pattern, with women less likely to receive an accurate prehospital working diagnosis of stroke (RR, 0.88; 95% CI, 0.81-0.96; P =.006). Similar results were observed among age-adjusted studies.

In 1 study (women, n=726; men, n=546) analyzing triage call data, no sex differences were observed in the likelihood of being dispatched with high urgency level (RR, 0.98; 95% CI, 0.83-1.15). Similarly, across 3 studies (women, n=370,138; men, 347,092) assessing the accuracy of dispatch coding, there were no significant sex differences in the proportion of patients assigned a stroke dispatch code (RR, 0.95; 95% CI, 0.88-1.02).

In addition, no sex differences were observed in studies examining EMS prenotification to the receiving hospital (RR, 0.98; 95% CI, 0.96-1.00), conveyance to a stroke center (RR, 0.99; 95% CI, 0.79-1.24), or time from the emergency call to hospital arrival (mean difference, 1.12 minutes; 95% CI, −0.64 to 2.89).

A lack of available data precluded the determination of sex differences for on-site clinical management, EMS-to-hospital team communication, and most time-related metrics.

Study limitations include heterogeneous studies and the limited number of studies that, although not designed to investigate sex differences, included subgroup analyses by sex.

“The available evidence demonstrates that females with acute stroke are less likely to be correctly identified as stroke suspects in the prehospital setting,” the authors wrote.

Disclosures: Some authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.