The George Institute for Global Health, University of New South Wales, Sydney, NSW.
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.
Med J Aust. 2022 Aug 1;217(3):143-148. doi: 10.5694/mja2.51652. Epub 2022 Jul 13.
To examine whether pre-hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke.
DESIGN, SETTING, PARTICIPANTS: Population-based cohort study; analysis of linked Admitted Patient Data Collection and NSW Ambulance data for people admitted to New South Wales hospitals with a principal diagnosis of stroke at separation, 1 July 2005 - 31 December 2018.
Emergency medical service assessments, protocols, and management for patients subsequently diagnosed with stroke, by sex.
Of 202 231 people hospitalised with stroke (mean age, 73 [SD, 14] years; 98 599 women [51.0%]), 101 357 were conveyed to hospital by ambulance (50.1%). A larger proportion of women than men travelled by ambulance (52.4% v 47.9%; odds ratio [OR], 1.09; 95% CI, 1.07-1.11), but time between the emergency call and emergency department admission was similar for both sexes. The likelihood of being assessed as having a stroke (adjusted OR [aOR], 0.97; 95% CI, 0.93-1.01) or subarachnoid haemorrhage (aOR, 1.22; 95% CI, 0.73-2.03) was similar for women and men, but women under 70 years of age were less likely than men to be assessed as having a stroke (aOR, 0.89; 95% CI, 0.82-0.97). Women were more likely than men to be assessed by paramedics as having migraine, other headache, anxiety, unconsciousness, hypertension, or nausea. Women were less likely than men to be managed according to the NSW Ambulance pre-hospital stroke care protocol (aOR, 0.95; 95% CI, 0.92-0.97), but the likelihood of basic pre-hospital care was similar for both sexes (aOR, 1.01; 95% CI, 0.99-1.04).
Our large population-based study identified sex differences in pre-hospital management by emergency medical services of women and men admitted to hospital with stroke. Paramedics should receive training that improves the recognition of stroke symptoms in women.
研究因卒中住院的女性和男性在院前急救医疗服务方面是否存在差异。
设计、地点、参与者：基于人群的队列研究；对 2005 年 7 月 1 日至 2018 年 12 月 31 日期间因主要诊断为卒中而在新南威尔士州医院住院的患者进行了链接的入院患者数据采集和新南威尔士州救护车数据的分析。
根据性别，评估、方案和管理随后被诊断为卒中的患者的急救医疗服务。
在 202231 名因卒中住院的患者（平均年龄 73 [标准差 14] 岁；98599 名女性 [51.0%]）中，有 101357 名患者通过救护车送往医院（50.1%）。女性乘坐救护车的比例高于男性（52.4%比 47.9%；优势比 [OR]，1.09；95%置信区间 [CI]，1.07-1.11），但紧急呼叫和急诊入院之间的时间相似。女性被评估为患有卒中的可能性（调整后的 OR [aOR]，0.97；95%CI，0.93-1.01）或蛛网膜下腔出血（aOR，1.22；95%CI，0.73-2.03）与男性相似，但 70 岁以下的女性被评估为患有卒中的可能性低于男性（aOR，0.89；95%CI，0.82-0.97）。女性比男性更有可能被护理人员评估为偏头痛、其他头痛、焦虑、无意识、高血压或恶心。女性根据新南威尔士州救护车院前卒中护理方案进行治疗的可能性低于男性（aOR，0.95；95%CI，0.92-0.97），但两性基本的院前护理可能性相似（aOR，1.01；95%CI，0.99-1.04）。
我们的大型基于人群的研究确定了因卒中住院的女性和男性在院前急救医疗服务管理方面的性别差异。护理人员应接受培训，以提高对女性卒中症状的识别。
