title: Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study.
abstract: BACKGROUND
  Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship.
  
  
  METHODS
  Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age.
  
  
  RESULTS
  1991 strokes (55% women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95% CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95% CI .78-1.28). This did not change across age or NIHSS categories.
  
  
  CONCLUSIONS
  After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women.
authors.affiliation: Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: tracy_madsen@brown.edu.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Madsen
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Heidi
authors.initials: H
authors.lastname: Sucharew
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Brian
authors.initials: B
authors.lastname: Katz
authors.affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Alwell
authors.affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Jason
authors.initials: J
authors.lastname: Mackey
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, Texas.
authors.forename: Sharyl
authors.initials: S
authors.lastname: Martini
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology, Sanna Healthcare Network, Lima, Peru.
authors.forename: Felipe
authors.initials: F
authors.lastname: De Los Rios La Rosa
authors.affiliation: Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult
keywords: Gender; acute stroke; delay; ischemic; stroke