Abstract WMP91: Disparities in Inpatient Mortality from Acute Stroke: Near-national Estimates for Hispanics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kori Sauser Zachrison ◽  
Mengyun Lin ◽  
Amresh Hanchate
Keyword(s):  
Acute Stroke ◽  
Patient Characteristics ◽  
National Sample ◽  
Inpatient Mortality ◽  
Discharge Data ◽  
Logistic Regression Models ◽  
Hispanic Patients ◽  
National Estimates ◽  
Race Ethnicity ◽  
Adjusted Model

Background: Hispanics are the largest minority in the US, yet there is little national data describing stroke outcomes among Hispanic patients. Objective: To measure inpatient mortality following admission for ischemic stroke (IS), hemorrhagic stroke (HS), and subarachnoid hemorrhage (SAH) among non-Hispanic blacks, non-Hispanic whites, and Hispanics. Methods: We combined discharge data (2010-11) from universe of admissions at all non-federal hospitals from 15 states that account for 85% of the Hispanic population and had near-complete reporting of race/ethnicity (AZ, CA, CO, FL, IL, MA, MD, NJ, NM, NV, NY, OR, PA, TX, VA). We identified all hospitalizations for IS, HS, and SAH, and estimated logistic and hospital-level hierarchical logistic regression models to obtain rates of inpatient mortality by race/ethnicity adjusted for patient characteristics (age, sex, race/ethnicity, comorbidities) and hospital characteristics (annual hospital stroke volume). Results: We found 567,498 discharges for acute stroke; Hispanics accounted for 11.7%, blacks for 15.6% and whites for 68.7%. Among all discharges, IS accounted for 83%, HS 12% and SAH 5%. Compared to whites, Hispanics and blacks were younger and had lower observed mortality rate for all stroke subtypes (IS: whites 5.2%, blacks 3.3%, Hispanics 4.3%, p<0.001; HS: whites 25.7%, blacks 20.8%, Hispanics 21.3%, p<0.001; and SAH: whites 20.2%, blacks 17.5%, Hispanics 19.3%, p<0.001). In the fully adjusted model, compared to whites, Hispanic inpatient mortality was lower for HS but nor for IS or SAH (Table); in contrast, blacks had lower inpatient mortality for IS and HS (Table). Individual states’ overall adjusted stroke mortality for all subgroups combined was not significantly different for Hispanics, with the exception of CA (OR 0.90, 95% CI 0.85-0.96). Conclusion: In a near-national sample, Hispanic patients had lower adjusted inpatient mortality rates than whites for HS, and similar rates for IS and SAH.

Abstract WMP58: The Smoker’s Paradox After Acute Ischemic Stroke, is it Real or a Cloud of Smoke?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Eva Mistry ◽  
Shadi Yaghi ◽  
Pooja Khatri ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Tobacco Use ◽  
Neurologic Outcome ◽  
Stroke Patients ◽  
Logistic Regression Models ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Adjusted Model

Background: Although tobacco use, the majority of which is cigarette smoking, increases the risk of incident stroke, there are inconsistent data regarding the effect of tobacco use on neurological outcomes after acute ischemic stroke. Several prior studies have suggested that smoking could be protective after stroke, which has been termed the "smoker’s paradox." Methods: We pooled three data sources to explore the effect of tobacco use on neurologic outcome in acute stroke patients. The first was the Blood Pressure after EVT in Stroke (BEST) study, the second was the NINDS tPA trial, and the third was the Interventional Management of Stroke (IMS) III trial. The primary outcome is 90-day mRS 0-2 (good outcome). We fit logistic regression models to good outcome, both unadjusted and adjusted for patient age, NIHSS, and sICH. Results: Our pooled cohort had 1,671 acute stroke patients, of which 480 (28.7%) used tobacco. In an unadjusted model, tobacco use was associated with good outcome (OR 1.42, 95% CI 1.15-1.76, p=0.001). However, in the adjusted model, this association was no longer significant (aOR 0.98, 95% CI 0.76-1.25, p=0.868). If we stratify by placebo-treated (n=310), tPA-treated (n=513), and EVT-treated (n=836), we continue to find that tobacco use is not associated with good neurologic outcome in adjusted analyses specific to these subgroups. An additional subgroup analysis of the EVT-treated patients that adjusted for successful procedural recanalization (TICI 2b-3) was not significant. Patients who used tobacco were younger (mean age, 60.5 vs. 69.2 years, p<0.001). Adjusting for age alone rendered the association between tobacco use and good outcome insignificant (aOR 1.05, 95% CI 0.84-1.32, p=0.666). Conclusions: This is the first adjusted analysis to examine the association between tobacco use and neurologic outcome in EVT-treated patients. We find that tobacco use is not protective after acute ischemic stroke that is untreated or treated with tPA or EVT. The univariate association of tobacco use with good outcome is accounted for by tobacco users being younger.

scholarly journals Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 2918-2924 ◽  
Author(s):  
Mai N. Nguyen-Huynh ◽  
Xian Nan Tang ◽  
David R. Vinson ◽  
Alexander C. Flint ◽  
Janet G. Alexander ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Large Vessel ◽  
Critical Conditions ◽  
Care Seeking ◽  
Northern California ◽  
Inpatient Mortality

Background and Purpose: Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes pre- and post-SIP orders. Methods: We conducted a cohort study in 21 stroke centers of an integrated healthcare system serving 4.4+ million members across Northern California. We included adult patients who presented with suspected acute stroke and were evaluated by telestroke between January 1, 2019, and May 9, 2020. SIP orders announced the week of March 15, 2020, created pre (January 1, 2019, to March 14, 2020) and post (March 15, 2020, to May 9, 2020) cohort for comparison. Main outcomes were stroke alert volumes and inpatient mortality for stroke. Results: Stroke alert weekly volume post-SIP (mean, 98 [95% CI, 92–104]) decreased significantly compared with pre-SIP (mean, 132 [95% CI, 130–136]; P <0.001). Stroke discharges also dropped, in concordance with acute stroke alerts decrease. In total, 9120 patients were included: 8337 in pre- and 783 in post-SIP cohorts. There were no differences in patient demographics. Compared with pre-SIP, post-SIP patients had higher National Institutes of Health Stroke Scale scores ( P =0.003), lower comorbidity score ( P <0.001), and arrived more often by ambulance ( P <0.001). Post-SIP, more patients had large vessel occlusions ( P =0.03), and there were fewer stroke mimics ( P =0.001). Discharge outcomes were similar for post-SIP and pre-SIP cohorts. Conclusions: In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. Compared with pre-SIP, the post-SIP population showed no significant demographic differences but had lower comorbidity scores, more severe strokes, and more large vessel occlusions. The inpatient mortality was similar in both cohorts. Further studies are needed to understand the causes and implications of care avoidance to patients and healthcare systems.

Abstract 16459: Racial and Ethnic Differences in Echocardiographic Abnormalities and Myocardial Injury in Patients With Covid-19: The CIRC-19 Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael S Miller ◽  
Gennaro Giustino ◽  
Annapoorna Kini ◽  
Giulio Stefanini ◽  
Renato Bragato ◽  
...  
Keyword(s):  
New York ◽  
Hospital Mortality ◽  
Race And Ethnicity ◽  
Myocardial Injury ◽  
Minority Groups ◽  
Racial And Ethnic Differences ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Hispanic Patients ◽  
Race Ethnicity

Introduction: Myocardial injury is common amongst patients hospitalized with Covid-19 and is associated with a poor prognosis. It is unknown whether its incidence and its mechanisms differ by race and ethnicity. Methods: We conducted a multicenter, international cohort study at 7 hospitals in New York (United States) and Milan (Italy) between March and May 2020. All patients were hospitalized, had laboratory-confirmed Covid-19, and received a transthoracic echocardiogram (TTE) during their hospitalization. We evaluated the association between race/ethnicity and myocardial injury in multivariable logistic regression models. Myocardial injury was defined as any cardiac troponin elevation above the upper limit of normal at each enrolling site. Results: A total of 305 consecutive patients were included, of whom 280 had self-reported race/ethnicity. Key demographic, laboratory and echocardiographic characteristics are presented in the Table. All minority groups had higher incidence of a composite of major echocardiographic abnormalities compared to whites, and Asian and Hispanic patients had increased incidence of RV dysfunction. In multivariable models, compared with Whites, Black (adjOR 2.7 [1.1-6.4]), Asian (adjOR 3.3 [1.1-10.2]), and Hispanic (adjOR 2.8 [1.4-5.8]) patients had increased odds of myocardial injury. After adjusting for baseline demographic and clinical variables, both Asian (adjOR 9.9 [2.6-38.6]) and Hispanic (adjOR 5.7 [2.1-15.6]) patients had increased odds of in-hospital mortality compared with White, but not Black (adjOR 2.0 [0.6-7.0]) patients. Conclusions: Among hospitalized patients with Covid-19 who received a TTE, minority groups had higher incidence of echocardiographic abnormalities and increased risk of myocardial injury. After adjustment for baseline confounders, only Asian and Hispanic patients remained at increased risk for in-hospital mortality.

Are Racial and Ethnic Disparities In Acute Myeloid Leukemia Due To Differences In Treatment?

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 726-726
Author(s):  
Manali I. Patel ◽  
Yifei Ma ◽  
Beverly S. Mitchell ◽  
Kim Rhoads
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Hispanic Patients ◽  
Race Ethnicity

Abstract Purpose In our previous work using the Surveillance Epidemiology and End Results (SEER) database, we demonstrated that despite younger age at presentation and a higher prevalence of favorable cytogenetic factors, black and Hispanic patients have increased mortality from Acute Myeloid Leukemia (AML) compared with non-Hispanic whites (NHW). The role of treatment has not been studied on a population level due to the limitations of SEER data with respect to treatment variables. The purpose of this study is to explore explanations for disparities in AML using a novel database containing both demographic and clinical variables. We will evaluate the relationship between the quality of AML care and outcomes. The hypothesis is that outcome disparities from AML may be explained by differences in receipt of treatment by race/ethnicity. Methods All patients with AML were identified in the California Cancer Registry (CCR) database linked to the hospital discharge abstracts from the Office of Statewide Health Planning and Development (OSHPD) during the years 1998-2008. Kaplan Meier (KM) survival curves were generated to predict survival probabilities by race/ethnicity. These were stratified by age based on our prior findings. Logistic regression models estimated the odds of treatment defined as chemotherapy and/or hematopoietic stem cell transplant by race/ethnicity. Cox proportional hazard models estimated the hazard of mortality by race with adjustment for age, gender, year of diagnosis, co-morbidities, and presence of the t(8;21), APL, and 11q23 subtypes. Models were further adjusted for receipt of treatment. Results A total of 11,084 patients were included in the study. Black and Hispanic patients were diagnosed at younger ages (<61 years) and had higher rates of APL subtype compared to NHWs. Hispanic and Asian/Pacific Islanders (API) patients had higher rates of t(8;21) subtypes compared to NHW. API and NHW had the highest rates of 11q23 subtype. Logistic regression models showed decreased odds of chemotherapy and hematopoietic stem cell transplant for black patients compared to NHW (0.74 95% CI (0.61-0.91); 0.62 95% CI (0.45-0.85), respectively) which persisted after adjustment for t(8;21), APL, and 11q23 subtypes. Odds of hematopoietic stem cell transplant were also decreased for Hispanic patients compared to NHW (0.68 95% CI (0.58-0.82)) despite adjustment for subtypes. Multivariable models adjusted for gender, age, year of diagnosis and comorbidities demonstrated that compared to NHW, blacks had an increased risk of death (1.15 95% CI (1.05-1.26)) whereas APIs had a decreased risk of death (0.84 95% CI (0.84-0.96)). Adjustment for t(8;21), APL, and 11q23 subtypes did not attenuate the disparity for blacks. Adjustment for treatment (chemotherapy and/or transplant) slightly moderated the risk of death (HR 1.10 95% CI (1.01-1.22)) for black patients. Conclusions Our work suggests that treatment differences may play a role in survival disparities from AML; however these differences do not completely explain the differences in survival. Socioeconomic status factors or unmeasured genetic factors may explain the observed differences. Future studies aimed at addressing disparities in AML should assess mortality with attention to these factors. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Massachusetts general hospital Covid-19 registry reveals two distinct populations of hospitalized patients by race and ethnicity

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244270
Author(s):  
Ingrid V. Bassett ◽  
Virginia A. Triant ◽  
Bridget A. Bunda ◽  
Caitlin A. Selvaggi ◽  
Daniel J. Shinnick ◽  
...  
Keyword(s):  
General Hospital ◽  
Race And Ethnicity ◽  
Massachusetts General Hospital ◽  
Data Extraction ◽  
Hospitalized Patients ◽  
Health Records ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Adjusted Model ◽  
Multivariable Adjusted Model

Objective To evaluate differences by race/ethnicity in clinical characteristics and outcomes among hospitalized patients with Covid-19 at Massachusetts General Hospital (MGH). Methods The MGH Covid-19 Registry includes confirmed SARS-CoV-2-infected patients hospitalized at MGH and is based on manual chart reviews and data extraction from electronic health records (EHRs). We evaluated differences between White/Non-Hispanic and Hispanic patients in demographics, complications and 14-day outcomes among the N = 866 patients hospitalized with Covid-19 from March 11, 2020—May 4, 2020. Results Overall, 43% of patients hospitalized with Covid-19 were women, median age was 60.4 [IQR = (48.2, 75)], 11.3% were Black/non-Hispanic and 35.2% were Hispanic. Hispanic patients, representing 35.2% of patients, were younger than White/non-Hispanic patients [median age 51y; IQR = (40.6, 61.6) versus 72y; (58.0, 81.7) (p<0.001)]. Hispanic patients were symptomatic longer before presenting to care (median 5 vs 3d, p = 0.039) but were more likely to be sent home with self-quarantine than be admitted to hospital (29% vs 16%, p<0.001). Hispanic patients had fewer comorbidities yet comparable rates of ICU or death (34% vs 36%). Nonetheless, a greater proportion of Hispanic patients recovered by 14 days after presentation (62% vs 45%, p<0.001; OR = 1.99, p = 0.011 in multivariable adjusted model) and fewer died (2% versus 18%, p<0.001). Conclusions Hospitalized Hispanic patients were younger and had fewer comorbidities compared to White/non-Hispanic patients; despite comparable rates of ICU care or death, a greater proportion recovered. These results have implications for public health policy and the design and conduct of clinical trials.

scholarly journals Massachusetts General Hospital Covid-19 Registry reveals two distinct populations of hospitalized patients by race and ethnicity

2020 ◽  
Author(s):  
Ingrid V Bassett ◽  
Virgina A Triant ◽  
Bridget A Bunda ◽  
Caitlin A Selvaggi ◽  
Daniel J Shinnick ◽  
...  
Keyword(s):  
General Hospital ◽  
Race And Ethnicity ◽  
Massachusetts General Hospital ◽  
Data Extraction ◽  
Hospitalized Patients ◽  
Health Records ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Adjusted Model ◽  
Multivariable Adjusted Model

Objective: To evaluate differences by race/ethnicity in clinical characteristics and outcomes among hospitalized patients with Covid-19 at Massachusetts General Hospital (MGH). Methods: The MGH Covid-19 Registry includes confirmed SARS-CoV-2-infected patients hospitalized at MGH and is based on manual chart reviews and data extraction from electronic health records (EHRs). We evaluated differences between White/Non-Hispanic and Hispanic patients in demographics, complications and 14-day outcomes among the N=866 patients hospitalized with Covid-19 from March 11, 2020 - May 4, 2020. Results: Overall, 43% of patients hospitalized with Covid-19 were women, median age was 60.4 [IQR = (48.2, 75)], 11.3% were Black/non-Hispanic and 35.2% were Hispanic. Hispanic patients, representing 35.2% of patients, were younger than White/non-Hispanic patients [median age 51y; IQR = (40.6, 61.6) versus 72y; (58.0, 81.7) (p<0.001)]. Hispanic patients were symptomatic longer before presenting to care (median 5 vs 3d, p=0.039) but were more likely to be sent home with self-quarantine than be admitted to hospital (29% vs 16%, p<0.001). Hispanic patients had fewer comorbidities yet comparable rates of ICU or death (34% vs 36%). Nonetheless, a greater proportion of Hispanic patients recovered by 14 days after presentation (62% vs 45%, p<0.001; OR = 1.99, p = 0.011 in multivariable adjusted model) and fewer died (2% versus 18%, p<0.001). Conclusions: Hospitalized Hispanic patients were younger and had fewer comorbidities compared to White/non-Hispanic patients; despite comparable rates of ICU care or death, a greater proportion recovered. These results have implications for public health policy and the design and conduct of clinical trials.

scholarly journals Characteristics of youth who leave the emergency department without being seen following sports-related concussion

Concussion ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. CNC68
Author(s):  
Jacquelyn J Deichman ◽  
Janessa M Graves ◽  
Tracy A Klein ◽  
Jessica L Mackelprang
Keyword(s):  
Emergency Department ◽  
Regression Models ◽  
Head Injuries ◽  
Patient Characteristics ◽  
Injury Surveillance System ◽  
Logistic Regression Models ◽  
Left Without Being Seen ◽  
National Estimates ◽  
Rising Incidence ◽  
Ed Visits

Aim: Despite the rising incidence of emergency department (ED) visits for sports-related concussion, the frequency and characteristics of youth leaving before being seen are unknown. Methodology: National estimates of ED visits for sports-related head injuries among youth (10–18 years) were generated for 2006–2017 using the National Electronic Injury Surveillance System. Logistic regression models estimated the odds of leaving without being seen across patient characteristics and time. Results: From 2006 to 2017, 985,966 (95% CI: 787,296–1,184,637) ED visits were identified for sports-related concussions, of which 5015 (95% CI: 3024–7006) left without being seen. Conclusion: Youth with sports-related concussion must receive timely care and ED improvements may reduce rates of leaving without being seen.

scholarly journals The Effects of Medicare Accountable Organizations on Inpatient Mortality Rates

2018 ◽  
Vol 55 ◽  
pp. 004695801880009 ◽  
Author(s):  
Eli Cutler ◽  
Zeynal Karaca ◽  
Rachel Henke ◽  
Michael Head ◽  
Herbert S. Wong
Keyword(s):  
Artery Bypass ◽  
Mortality Rates ◽  
Inpatient Mortality ◽  
Discharge Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Logistic Regression Models ◽  
Annual Survey ◽  
Abdominal Aortic ◽  
Care Systems

Studies have linked Accountable Care Organizations (ACOs) to improved primary care, but there is little research on how ACOs affect care in other settings. We examined whether Medicare ACOs have improved hospital quality of care, specifically focusing on preventable inpatient mortality. We used 2008-2014 Healthcare Cost and Utilization Project hospital discharge data from 34 states’ Medicare ACO and non-ACO hospitals in conjunction with data from the American Hospital Association Annual Survey and the Survey of Care Systems and Payment. We estimated discharge-level logistic regression models that measured the relationship between ACO affiliation and mortality following admissions for acute myocardial infarction, abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting, and pneumonia, controlling for patient demographic mix, hospital, and year. Our results suggest that, on average, Medicare ACO hospitals are not associated with improved mortality rates for the studied IQI conditions. Stakeholders may potentially consider providing ACOs with incentives or designing new programs for ACOs to target inpatient mortality reductions.

scholarly journals The Effects of Race, Ethnicity, and Mood/Anxiety Disorders on the Chronic Physical Health Conditions of Men From a National Sample

2013 ◽  
Vol 7 (4_suppl) ◽  
pp. 58S-67S ◽  
Author(s):  
Vicki Johnson-Lawrence ◽  
Derek M. Griffith ◽  
Daphne C. Watkins
Keyword(s):  
Anxiety Disorders ◽  
Physical Health ◽  
Race And Ethnicity ◽  
White Men ◽  
National Sample ◽  
Health Conditions ◽  
Logistic Regression Models ◽  
Physical Health Problems ◽  
Race Ethnicity ◽  
Using Data

Racial/ethnic differences in health are evident among men. Previous work suggests associations between mental and physical health but few studies have examined how mood/anxiety disorders and chronic physical health conditions covary by age, race, and ethnicity among men. Using data from 1,277 African American, 629 Caribbean Black, and 371 non-Hispanic White men from the National Survey of American Life, we examined associations between race/ethnicity and experiencing one or more chronic physical health conditions in logistic regression models stratified by age and 12-month mood/anxiety disorder status. Among men <45 years without mood/anxiety disorders, Caribbean Blacks had lower odds of chronic physical health conditions than Whites. Among men aged 45+ years with mood/anxiety disorders, African Americans had greater odds of chronic physical health conditions than Whites. Future studies should explore the underlying causes of such variation and how studying mental and chronic physical health problems together may help identify mechanisms that underlie racial disparities in life expectancy among men.

Abstract W P212: The Effect Of Pre-hospital Notification On Time To Head Ct, Stroke Specialist Arrival, And Tpa Administration For Hispanic Patients With Acute Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jonathan McCoy ◽  
Ralph Fader ◽  
Colleen Donovan ◽  
Robert Eisenstein ◽  
Pamela Ohman-Strickland ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Independent Effect ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Head Ct ◽  
Logistic Regression Models ◽  
Hispanic Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Hispanics have an increased incidence of ischemic stroke but may be less likely to use Emergency Medical Services (EMS) for stroke care. Objective: To examine disparities in pre-hospital triage and emergent evaluation of Hispanic stroke patients. We hypothesized that Hispanic stroke patients with pre-hospital notification experience less delay in emergent evaluation but the reduction may not be as pronounced as general stroke patients. Methods: Retrospective cohort study of all emergency department patients alerted as Brain Attack (BAT) between January 1, 2009 and August 31, 2012, at an urban comprehensive stroke center. We collected demographics, co-morbidities, and stroke severity from a quality assurance database. Outcome variables included EMS utilization, pre-hospital BAT activation, head CT timing & tissue plasminogen activator (TPA) timing. Effects of ethnicity and pre-hospital notification on evaluation and treatment times were measured using multivariate logistic regression models. The study was IRB approved. Results: During the study period, 832(64 Hispanic) patients were alerted as Brain Attacks. Hispanic patients were younger 56±17 vs. 68±16 years (p<0.0001), had trends for less EMS utilization (walk-in 35% vs. 22%) and lower NIHSS 9.3±4.3 vs. 12.8±8.3 (p=0.06), but did not differ in comorbidities. Patients with pre-hospital notification had significantly shorter times to stroke specialist arrival, door to head CT, and door to TPA irrespective of ethnicity. However, ethnicity did have independent effect on time to TPA administration. Please see Table 1. Conclusion: Pre-hospital notification is associated with faster stroke evaluation and treatment, including among Hispanic patients with acute stroke. Further study is needed to examine if outreach to increase EMS utilization will decrease disparities in this population.

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