The Effect of Biological Sex on a County Pre-hospital Stroke Initiative

Abstract

Background: Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes. Methods: An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences. Results: 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS ( F(1) = 6.25, p < .05) and discharge NIHSS ( F(1) = 8.588, p < .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p < .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69). Conclusions: The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.