Sex differences in stroke evaluations in the Ischemic Stroke Genetics Study.
BACKGROUND
Epidemiologic studies suggest sex differences in evaluation of patients presenting with ischemic stroke. Sex differences in stroke evaluation could lead to sex differences in the validity of diagnosing ischemic stroke subtypes. This study assessed sex differences in the Ischemic Stroke Genetics Study (ISGS).


METHODS
The ISGS is a prospective case-control genetic association study of patients with first-ever ischemic stroke at 5 US tertiary stroke centers. The diagnostic tests performed as part of medical care were recorded for each enrolled patient.


RESULTS
A total of 505 patients were enrolled; 45% (229 of 505) were women and 55% (276 of 505) were men. Mean age at time of stroke was greater for women (66.6 v 61.9 years; P = .001). Frequency of brain computed tomography was 92% (254 of 276) for men and 90% (206 of 229) for women (P = .42). Magnetic resonance imaging was completed in 84% (232 of 276) of men and 83% (191 of 229) of women (P = .91). Frequency of electrocardiography was 91% (252 of 276) for men and 90% (206 of 229) for women (P = .60). Echocardiography was done in 74% (203 of 276) of men and 79% (180 of 229) of women (P = .19). Cervical arterial imaging occurred in 91% (208 of 229) of women and 86% (237 of 276) of men (P = .09). Intracranial vascular imaging was performed in 75% (207 of 276) of men and 79% (181 of 229) of women (P = .28).


CONCLUSIONS
Our findings suggest no significant sex differences in the extent to which major diagnostic tests were performed in patients in ISGS. Dedicated tertiary stroke centers may reduce the sex bias in stroke evaluation that has been identified by previous studies.
Leslie-Mazwi
Thabele M
TM
Department of Neurology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Brott
Thomas G
TG
Brown
Robert D
RD
Worrall
Bradford B
BB
Silliman
Scott L
SL
Case
L Douglas
LD
Frankel
Michael R
MR
Rich
Stephen S
SS
Meschia
James F
JF
D000368:Aged; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D016022:Case-Control Studies; D002533:Cerebral Angiography; D003952:Diagnostic Imaging / Q000379:methods* / Q000706:statistics & numerical data; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology