Ajinkya Shaun, Almallouhi Eyad, Turner Nancy, Al Kasab Sami, Holmstedt Christine A
Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Neurology, University of Iowa, Iowa City, Iowa, USA.
Telemed J E Health. 2020 Oct;26(10):1221-1225. doi: 10.1089/tmj.2019.0127. Epub 2019 Nov 22.
The growth of telestroke services expanded the reach of acute stroke treatment. However, ethnic disparities in receiving such treatment have not been fully assessed. We reviewed prospectively maintained data on patients evaluated through the Medical University of South Carolina telestroke program between January 2016 and November 2018. Outcomes included odds of receiving intravenous recombinant tissue plasminogen activator (tPA), receiving mechanical thrombectomy (MT), and achieving door-to-needle (DTN) time ≤60 and ≤45 min among patients receiving tPA. We used logistic regression to analyze the contribution of race/ethnicity. We included 2,977 patients, of whom 1,093 (36.7%) identified as nonwhite; of these, 1,048 patients (95.9%) identified as black or African American. Significantly more nonwhite patients were seen at a primary stroke center (PSC) (68.4% vs. 52.3% in whites, p < 0.001). However, white patients had significantly higher odds of receiving tPA (odds ratio [OR] 1.47, confidence interval [95% CI] 1.17-1.84). There was no significant difference in receiving MT between races. Among patients receiving tPA, whites had higher odds of DTN ≤45 min (OR 1.76, 1.20-2.57) and ≤60 min (OR 1.87, 95% CI 1.31-2.66). White patients had better odds achieving DTN ≤45 min and DTN ≤60 min if receiving tPA within a telestroke setting, as well as higher odds of receiving tPA, even after adjustment for comorbidities. This was noted despite white patients having less access to PSCs. However, larger scale studies are needed to further study the impact of ethnic disparities.
远程卒中服务的发展扩大了急性卒中治疗的覆盖范围。然而，接受此类治疗中的种族差异尚未得到充分评估。我们回顾性分析了2016年1月至2018年11月期间通过南卡罗来纳医科大学远程卒中项目评估的患者的前瞻性维护数据。结局指标包括接受静脉注射重组组织型纤溶酶原激活剂（tPA）、接受机械取栓术（MT）以及在接受tPA治疗的患者中实现门到针（DTN）时间≤60分钟和≤45分钟的几率。我们使用逻辑回归分析种族/民族的影响。我们纳入了2977例患者，其中1093例（36.7%）被认定为非白人；在这些非白人患者中，1048例（95.9%）被认定为黑人或非裔美国人。在初级卒中中心（PSC）就诊的非白人患者明显更多（68.4%对白人中的52.3%，p＜0.001）。然而，白人患者接受tPA的几率显著更高（优势比[OR]1.47，置信区间[95%CI]1.17 - 1.84）。不同种族在接受MT方面没有显著差异。在接受tPA治疗的患者中，白人实现DTN≤45分钟（OR 1.76，1.20 - 2.57）和≤60分钟（OR 1.87，95%CI 1.31 - 2.66）的几率更高。即使在调整合并症后，白人患者在远程卒中环境中接受tPA时实现DTN≤45分钟和DTN≤60分钟的几率更好，接受tPA的几率也更高。尽管白人患者进入PSC的机会较少，但仍观察到这种情况。然而，需要更大规模的研究来进一步探讨种族差异的影响。
