Sevilis Theresa, Avila Amanda, McDonald Mark, Fowler Mariecken, Chalfin Renata, Amir Murtaza, Heath Gregory, Zaman Mohammed, Avino Lorianne, Boyd Caitlyn, Gao Lan, Devlin Thomas
TeleSpecialists, LLC, Fort Myers, FL, United States.
Public Health, University of Tennessee at Chattanooga, Chattanooga, TN, United States.
Front Neurol. 2023 Jun 21;14:1203502. doi: 10.3389/fneur.2023.1203502. eCollection 2023.
Previous studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR reported as low as 0.57 and worse outcomes. With updated standards of care and improved access to care through telestroke, there is potential to reduce or alleviate these disparities.
Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare by TeleSpecialists database. The encounters were reviewed for demographics, stroke time metrics, thrombolytics candidate, premorbid modified Rankin Score, NIHSS score, stroke risk factors, antithrombotic use, admitting diagnosis of suspected stroke, and reason not treated with thrombolytic. The treatment rates, door to needle (DTN) times, stroke metric times, and variables of treatment were compared for females and males.
There were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75-0.97, = 0.006). Median DTN times were shorter for males than females (38 vs. 41 min, < 0.001). Male patients were more likely to have an admitting diagnosis of suspected stroke, < 0.001. Analysis by age showed the only decade with significant difference in thrombolytics treatment rate was 50-59 with increased treatment of males, = 0.047. When multivariant logistic regression analysis was performed with stroke risk factors, NIHSS score, age, and admitting diagnosis of suspected stroke, the adjusted odds ratio for females was 0.9 (95% CI 0.8, 1.01), = 0.064.
While treatment differences between sexes existed in the data and were apparent in univariate analysis, no significant difference was seen in multivariate analysis once stroke risk factors, age, NIHSS score and admitting diagnosis were taken into consideration in the telestroke setting. Differences in rates of thrombolysis between sexes may therefore be reflective of differences in risk factors and symptomatology rather than a healthcare disparity.
既往研究显示，中风治疗存在性别差异。女性患者的溶栓治疗率较低，比值比（OR）低至0.57，且预后较差。随着护理标准的更新以及通过远程中风医疗改善了医疗服务可及性，有可能减少或缓解这些差异。
从TeleSpecialists公司的远程医疗数据库中提取了2021年1月1日至2021年4月30日期间在203家机构（23个州）急诊科由TeleSpecialists公司医生进行的急性中风会诊。对这些会诊病例进行回顾，分析人口统计学特征、中风时间指标、溶栓候选情况、病前改良Rankin量表评分、美国国立卫生研究院卒中量表（NIHSS）评分、中风危险因素、抗栓药物使用情况、疑似中风的入院诊断以及未接受溶栓治疗的原因。比较了女性和男性的治疗率、门到针（DTN）时间、中风指标时间以及治疗变量。
共纳入18783例患者（10073例女性和8710例男性）。其中，6.9%的女性接受了溶栓治疗，而男性为7.9%（OR 0.86，95%置信区间0.75 - 0.97，P = 0.006）。男性的DTN中位数时间比女性短（38分钟对41分钟，P < 0.001）。男性患者更有可能被诊断为疑似中风入院，P < 0.001。按年龄分析显示，溶栓治疗率有显著差异的唯一十年是50 - 59岁，男性治疗率更高，P = 0.047。当对中风危险因素、NIHSS评分、年龄和疑似中风的入院诊断进行多变量逻辑回归分析时，女性的调整后比值比为0.9（95%置信区间0.8，1.01），P = 0.064。
虽然数据中存在性别治疗差异，且在单变量分析中很明显，但在远程中风医疗环境中，一旦考虑中风危险因素、年龄、NIHSS评分和入院诊断，多变量分析中未发现显著差异。因此，性别之间溶栓率的差异可能反映了危险因素和症状学的差异，而非医疗保健方面的差异。
