Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, plan 3, SE-413 45, Gothenburg, Sweden.
PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
Scand J Trauma Resusc Emerg Med. 2019 May 2;27(1):53. doi: 10.1186/s13049-019-0630-6.
Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).
Consecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient's neighbourhood (postcode area).
The median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport.
We found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses' ability to recognise stroke/TIA may partly explain the observed inequities.
近期研究揭示了脑卒中结局存在社会经济差异。在此，我们研究了卒中前医疗照护是否存在社会经济地位（SES）差异。
2014 年 11 月 1 日至 2016 年 7 月 31 日，连续纳入瑞典哥德堡萨尔格伦斯卡大学医院卒中单元收治的 3006 例卒中和 TIA 患者。从当地卒中登记处获取卒中前医疗照护的数据。根据患者所在街区（邮政编码区）的平均收入和教育水平对 SES 进行分类。
SES 最低三分位组的患者从拨打急救医疗通讯中心（EMCC）到到达医院开始脑 CT 的中位系统延迟为 3 h 47 min（95%置信区间[CI]为 3 h 30 min 至 4 h 05 min），SES 最高三分位组的患者为 3 h 17 min（95%CI 为 3 h 00 min 至 3 h 37 min）（p<0.05）。SES 较低的患者在救护车上获得较高优先级的可能性较低（p<0.05），且卒中/TIA 院前识别率较低（p<0.05），SES 较高的患者。在 EMCC 优先排序或救护车转运概率方面未发现不平等现象。
我们发现卒中前医疗照护存在社会经济不平等，这可能会影响急性卒中治疗的效果。救护车上护士识别卒中/TIA 的能力可能部分解释了观察到的不平等现象。
