Sex Differences in Prehospital Stroke Medicine (SESAME): A Systematic Review and Meta-Analysis.

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-10-01 Epub Date: 2025-08-04 DOI:10.1161/STROKEAHA.124.050414

Brittany Wells, Ahmed Nasreldein, Karianne Larsen, Frederike van Wijck, Cheryl Carcel, Hanne Christensen, Maren Ranhoff Hov, Valeria Caso, Mark Woodward, Deidre Anne De Silva, Thanh N Nguyen, Vilde Teigene Maloy, Maria Ignacia Allende, Priscilla Abrafi Opare-Addo, Klaus Fassbender, Monika Bachhuber, Else C Sandset, Silke Walter

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引用次数: 0

Abstract

Background: Several studies have evaluated sex discrepancies in the prehospital management of patients with acute stroke. This systematic review and meta-analysis aims to summarize reported knowledge about sex differences in dispatch center and emergency medical service management. It proposes a roadmap of questions and the next necessary steps to ensure equitable prehospital stroke care.

Methods: We conducted a systematic review and meta-analysis, using a random-effects model with inverse weighting. PubMed, CINAHL, EMBASE, and EMCARE were searched for studies investigating sex differences in the prehospital management of patients with suspected and acute stroke. The main outcome was the relative risk (RR) for receiving a correct prehospital stroke diagnosis. Additional outcomes are related to prehospital management and time metrics.

Results: Sixteen studies were included, comprising 571 024 male patients and 622 764 female patients. No relevant risk of bias was detected. Female patients were less often correctly identified as stroke suspects than male patients (RR, 0.92 [95% CI, 0.89-0.96]; I²=73%). No differences were observed in the number receiving a dispatch code stroke (RR, 0.95 [95% CI, 0.88-1.02]; I²=96%), prenotification to hospital by emergency medical service (RR, 0.98 [95% CI, 0.96-1.00]; I²=92%), or conveyance to a stroke center (RR, 0.99 [95% CI, 0.79-1.24]; I²=82%). There was no difference in mean time from emergency call to hospital door (mean difference, 1.12 [95% CI, -0.64 to 2.89] minutes; I²=96%). No conclusion could be drawn for outcomes of on-site clinical management, emergency medical service-to-hospital team interaction, and most of the time metrics due to a lack of data.

Conclusions: This analysis indicates sex differences in the prehospital recognition of acute stroke. However, significant heterogeneity and a lack of data for most steps of prehospital care also highlight the urgent need for high-quality studies to systematically investigate prehospital management disparity between female and male patients with suspected acute stroke.

Registration: URL: https://crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023442997.

查看原文本刊更多论文

院前卒中医学的性别差异（SESAME）：一项系统回顾和meta分析。

背景：几项研究评估了急性脑卒中患者院前管理的性别差异。本系统综述和荟萃分析旨在总结已报道的关于调度中心和紧急医疗服务管理性别差异的知识。它提出了问题路线图和下一步必要步骤，以确保公平的院前卒中护理。方法：采用逆加权随机效应模型进行系统评价和meta分析。检索PubMed、CINAHL、EMBASE和EMCARE，以调查疑似急性卒中患者院前管理的性别差异。主要结局是接受正确院前卒中诊断的相对危险度（RR）。其他结果与院前管理和时间指标有关。结果：纳入16项研究，男性571 024人，女性622 764人。未发现相关的偏倚风险。女性患者被正确识别为卒中疑似患者的比例低于男性患者(RR, 0.92 [95% CI, 0.89-0.96]；I2 = 73%)。在接受调度代码卒中的人数上没有观察到差异(RR, 0.95 [95% CI, 0.88-1.02]；I2=96%)，紧急医疗服务预先通知医院(RR, 0.98 [95% CI, 0.96-1.00]；I2=92%)，或转移到卒中中心(RR, 0.99 [95% CI, 0.79-1.24]；I2 = 82%)。从紧急呼叫到医院门口的平均时间没有差异(平均差异为1.12分钟[95% CI， -0.64至2.89]分钟；I2 = 96%)。由于缺乏数据，现场临床管理、紧急医疗服务与医院团队互动以及大多数时间指标的结果无法得出结论。结论：本分析提示急性脑卒中院前认知存在性别差异。然而，显著的异质性和缺乏院前护理大多数步骤的数据也突出了迫切需要高质量的研究来系统地调查女性和男性疑似急性卒中患者院前管理差异。注册：网址：https://crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42023442997。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.