College of Pharmacy, Ohio State University, Columbus, Ohio (former institution); Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina (current institution).
Center for Medication Use, Policy and Economics, Schools of Pharmacy and Public Health, University of Michigan, Ann Arbor, Michigan.
J Stroke Cerebrovasc Dis. 2011 Jan-Feb;20(1):30-40. doi: 10.1016/j.jstrokecerebrovasdis.2009.10.006. Epub 2010 Jun 9.
Emergency department waiting time (EDWT), the time from arrival at the ED to evaluation by an emergency physician, is a critical component of acute stroke care. We assessed racial/ethnic differences in EDWT in a national sample of patients with ischemic or hemorrhagic stroke. We identified 543 ED visits for ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 433.x1, 434.xx, and 436.xx) and hemorrhagic stroke (ICD-9-CM codes 430.xx, 431.xx, and 432.xx) in persons age ≥ 18 years representing 2.1 million stroke-related ED visits in the United States using the National Hospital Ambulatory Medical Care Survey for years 1997-2000 and 2003-2005. Using linear regression (outcome, log-transformed EDWT) and logistic regression (outcome, EDWT > 10 minutes, based on National Institute of Neurological Disorders and Stroke guidelines), we adjusted associations between EDWT and race/ethnicity (non-Hispanic whites [designated whites herein], non-Hispanic blacks [blacks], and Hispanics) for age, sex, region, mode of transportation, insurance, hospital characteristics, triage status, hospital admission, stroke type, and survey year. Compared with whites, blacks had a longer EDWT in univariate analysis (67% longer, P = .03) and multivariate analysis (62% longer, P = .03), but Hispanics had a similar EDWT in both univariate analysis (31% longer, P = .65) and multivariate analysis (5% longer, P = .91). Longer EDWT was also seen with nonambulance mode of arrival, urban hospitals, or nonemergency triage. Race was significantly associated with EDWT > 10 minutes (whites, 55% [referent]; blacks, 70% [P = .03]; Hispanics, 62% [P = .53]). These differences persisted after adjustment (blacks: odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.05-4.09; Hispanics: OR = 1.07, 95% CI = 0.52-2.22). Blacks, but not Hispanics, had significantly longer EDWT than whites. The longer EDWT in black stroke patients may lead to treatment delays and sub-optimal stroke care.
急诊科候诊时间（EDWT），即从到达急诊科到急诊医师评估的时间，是急性脑卒中护理的关键组成部分。我们评估了全国范围内缺血性或出血性脑卒中患者中 EDWT 的种族/民族差异。我们在美国使用 1997-2000 年和 2003-2005 年国家医院门诊医疗调查，在年龄≥18 岁的患者中识别出 543 例缺血性脑卒中（国际疾病分类，第九修订版，临床修正[ICD-9-CM]代码 433.x1、434.xx 和 436.xx）和出血性脑卒中（ICD-9-CM 代码 430.xx、431.xx 和 432.xx）的急诊就诊，代表了美国 210 万例与脑卒中相关的急诊就诊。使用线性回归（结果，对数转换后的 EDWT）和逻辑回归（结果，根据国立神经疾病与卒中研究所指南，EDWT>10 分钟），我们调整了 EDWT 与种族/民族（非西班牙裔白人[此处指定为白人]、非西班牙裔黑人[黑人]和西班牙裔）之间的关联，调整了年龄、性别、地区、交通方式、保险、医院特征、分诊状态、住院、脑卒中类型和调查年份。与白人相比，黑人在单变量分析（长 67%，P =.03）和多变量分析（长 62%，P =.03）中 EDWT 更长，但西班牙裔在单变量分析（长 31%，P =.65）和多变量分析中 EDWT 相似（长 5%，P =.91）。非救护车到达方式、城市医院或非紧急分诊也会导致 EDWT 延长。种族与 EDWT>10 分钟显著相关（白人，55%[参考]；黑人，70%[P =.03]；西班牙裔，62%[P =.53]）。这些差异在调整后仍然存在（黑人：优势比[OR] = 2.08，95%置信区间[CI] = 1.05-4.09；西班牙裔：OR = 1.07，95% CI = 0.52-2.22）。黑人，而不是西班牙裔，EDWT 明显长于白人。黑人脑卒中患者的 EDWT 较长可能导致治疗延迟和脑卒中护理效果不佳。
