Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Menon, S. C.
Right arrow Articles by Morgenstern, L. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Menon, S. C.
Right arrow Articles by Morgenstern, L. B.
NEUROLOGY 1998;51:427-432
© 1998 American Academy of Neurology

Critical factors determining access to acute stroke care

Sindhu C. Menon, BS, Dilip K. Pandey, MBBS, PhD and Lewis B. Morgenstern, MD

From the Department of Neurology (S. Menon and Dr. Morgenstern), The University of Texas Medical School, and the Epidemiology Research Center(Drs. Pandey and Morgenstern), The University of Texas School of Public Health, Houston, TX.

Address correspondence and reprint request to Dr. Lewis B. Morgenstern, Department of Neurology, The University of Texas, Houston, 6431 Fannin, Room 7.044, Houston, TX 77030.

Objective: Our objective was to assess gender, ethnic, and access-to-care factors critical in delay time (DT) for presentation to the hospital for acute stroke.

Background: Little information is available on the effect of gender, ethnicity, and access issues on DT.

Design: Demographic, access-to-care, and DT information was obtained from emergency department (ED) documentation of stroke patients admitted from July 1995 through June 1997 at Hermann Hospital, Houston, TX. Univariate and multivariate regression analyses were performed.

Results: Of the 241 eligible patients, 126 were African American (AA), 82 were non-Hispanic white (NHW), and 33 were Hispanic American (HA). Median DT from symptom onset to presentation to the ED was 222 minutes for AAs, 280 minutes for HAs, and 230 minutes for NHWs. A multivariate regression model estimated DT to ED arrival decreased with ambulance transport (p= 0.003) and increased in patients with a primary care physician(p = 0.145) and in women (p = 0.052). DT to see an ED physician after hospital arrival decreased with ambulance transport (p < 0.001), hemorrhage patients (p = 0.006), and worse stroke severity (p = 0.038), and increased in women (p = 0.041). DT to see a neurologist decreased with hemorrhage (p = 0.002) and ambulance arrival (p = 0.010). Neurologists saw patients within 3 hours of symptom onset in 34% of NHWs, 28% of AAs, and 18% of HAs.

Conclusion: Gender and access-to-care issues may be important determinants of delay in acute stroke care. Less than 20% of HAs presented to the ED within 3 hours of symptom onset.

Supported by The National Institute of Diabetes and Digestive and Kidney Diseases, T35DK07676 (S.C.M.), and by an American Heart Association Clinician

Scientist Award and the Temple Foundation (L.B.M.).

Received February 16, 1998. Accepted in final form April 3, 1998.




This article has been cited by other articles:


Home page
 StrokeHome page
L. D. Lisabeth, D. L. Brown, R. Hughes, J. J. Majersik, and L. B. Morgenstern
Acute Stroke Symptoms: Comparing Women and Men
Stroke, June 1, 2009; 40(6): 2031 - 2036.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
M. Reeves, A. Bhatt, P. Jajou, M. Brown, and L. Lisabeth
Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke: A Meta-Analysis
Stroke, May 1, 2009; 40(5): 1743 - 1749.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. W. Gargano, S. Wehner, and M. J. Reeves
Do Presenting Symptoms Explain Sex Differences in Emergency Department Delays Among Patients With Acute Stroke?
Stroke, April 1, 2009; 40(4): 1114 - 1120.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
M. J. Reeves, G. C. Fonarow, X. Zhao, E. E. Smith, L. H. Schwamm, and on behalf of the GWTG-Stroke Steering Committee &
Quality of Care in Women With Ischemic Stroke in the GWTG Program
Stroke, April 1, 2009; 40(4): 1127 - 1133.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
D. M. Frendl, D. G. Strauss, B. K. Underhill, and L. B. Goldstein
Lack of Impact of Paramedic Training and Use of the Cincinnati Prehospital Stroke Scale on Stroke Patient Identification and On-Scene Time
Stroke, March 1, 2009; 40(3): 754 - 756.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
S. V. Eden, W. J. Meurer, B. N. Sanchez, L. D. Lisabeth, M. A. Smith, D. L. Brown, and L. B. Morgenstern
Gender and ethnic differences in subarachnoid hemorrhage
Neurology, September 2, 2008; 71(10): 731 - 735.
[Abstract] [Full Text] [PDF]

Home page
 JAOA: Journal of the American Osteopathic AssociationHome page
B. L. Perrotta and A. L. Perrotta
Access to State-of-the-Art Healthcare: a Missing Dynamic in Consumer Selection of a Retirement Community
J Am Osteopath Assoc, June 1, 2008; 108(6): 297 - 305.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
A Maestroni, C Mandelli, D Manganaro, B Zecca, P Rossi, V Monzani, and G Torgano
Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy
Emerg. Med. J., June 1, 2008; 25(6): 340 - 345.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. M. Reid, D. Dai, G. J. Gubitz, M. K. Kapral, C. Christian, and S. J. Phillips
Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital
Stroke, April 1, 2008; 39(4): 1090 - 1095.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. Juhl Majersik, M. A. Smith, D. B. Zahuranec, B. N. Sanchez, and L. B. Morgenstern
Population-Based Analysis of the Impact of Expanding the Time Window for Acute Stroke Treatment
Stroke, December 1, 2007; 38(12): 3213 - 3217.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
L. B. Morgenstern, N. R. Gonzales, K. E. Maddox, D. L. Brown, A. P. Karim, N. Espinosa, L. A. Moye, J. K. Pary, J. C. Grotta, L. D. Lisabeth, et al.
A Randomized, Controlled Trial to Teach Middle School Children to Recognize Stroke and Call 911: The Kids Identifying and Defeating Stroke Project
Stroke, November 1, 2007; 38(11): 2972 - 2978.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Circulation, May 22, 2007; 115(20): e478 - e534.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Stroke, May 1, 2007; 38(5): 1655 - 1711.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
J. M. Reid, G. J. Gubitz, S. J. Phillips, M. J. Reeves, Y. Deng, and J. Gargano
IV tissue plasminogen activator use in acute stroke: experience from a statewide registry.
Neurology, November 14, 2006; 67(9): 1724 - 1725.
[Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
G Citerio, D Galli, and A Pesenti
Early stroke care in Italy--a steep way ahead: an observational study.
Emerg. Med. J., August 1, 2006; 23(8): 608 - 611.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
D. K. Moser, L. P. Kimble, M. J. Alberts, A. Alonzo, J. B. Croft, K. Dracup, K. R. Evenson, A. S. Go, M. M. Hand, R. U. Kothari, et al.
Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council
Circulation, July 11, 2006; 114(2): 168 - 182.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
Place of Death After Stroke--United States, 1999-2002
JAMA, June 21, 2006; 295(23): 2717 - 2718.
[Full Text] [PDF]

Home page
 StrokeHome page
O. Agyeman, K. Nedeltchev, M. Arnold, U. Fischer, L. Remonda, J. Isenegger, G. Schroth, and H. P. Mattle
Time to Admission in Acute Ischemic Stroke and Transient Ischemic Attack
Stroke, April 1, 2006; 37(4): 963 - 966.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
D B Zahuranec, N R Gonzales, D L Brown, L D Lisabeth, P J Longwell, S V Eden, M A Smith, N M Garcia, J T Hoff, and L B Morgenstern
Presentation of intracerebral haemorrhage in a community.
J. Neurol. Neurosurg. Psychiatry, March 1, 2006; 77(3): 340 - 344.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
H. F. McGruder, J. B. Croft, and Z.-J. Zheng
Characteristics of an "Ill-Defined" Diagnosis for Stroke: Opportunities for Improvement
Stroke, March 1, 2006; 37(3): 781 - 789.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
Y. Z. Deng, M. J. Reeves, B. S. Jacobs, G. L. Birbeck, R. U. Kothari, S. L. Hickenbottom, A. J. Mullard, S. Wehner, K. Maddox, A. Majid, et al.
IV tissue plasminogen activator use in acute stroke: Experience from a statewide registry
Neurology, February 14, 2006; 66(3): 306 - 312.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
M. A. Smith, L. D. Lisabeth, D. L. Brown, and L. B. Morgenstern
Gender comparisons of diagnostic evaluation for ischemic stroke patients
Neurology, September 27, 2005; 65(6): 855 - 858.
[Abstract] [Full Text] [PDF]

Home page
 Journals of Gerontology Series A: Biological Sciences and Medical SciencesHome page
S. A. Grossman, N. I. Shapiro, S. Van Epp, R. Kohen, R. Arnold, R. Moore, L. Lee, R. E. Wolfe, and L. A. Lipsitz
Sex Differences in the Emergency Department Evaluation of Elderly Patients With Syncope
J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2005; 60(9): 1202 - 1205.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. Prosser, K. Butcher, L. Allport, M. Parsons, L. MacGregor, P. Desmond, B. Tress, and S. Davis
Clinical-Diffusion Mismatch Predicts the Putative Penumbra With High Specificity
Stroke, August 1, 2005; 36(8): 1700 - 1704.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
A. W. Wojner-Alexandrov, A. V. Alexandrov, D. Rodriguez, D. Persse, and J. C. Grotta
Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO)
Stroke, July 1, 2005; 36(7): 1512 - 1518.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
L. B. Goldstein and D. L. Simel
Is This Patient Having a Stroke?
JAMA, May 18, 2005; 293(19): 2391 - 2402.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
J. P. Stansbury, H. Jia, L. S. Williams, W. B. Vogel, and P. W. Duncan
Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes
Stroke, February 1, 2005; 36(2): 374 - 386.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
K.-C. Chang, M.-C. Tseng, and T.-Y. Tan
Prehospital Delay After Acute Stroke in Kaohsiung, Taiwan
Stroke, March 1, 2004; 35(3): 700 - 704.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
L. B. Morgenstern, L. K. Bartholomew, J. C. Grotta, L. Staub, M. King, and W. Chan
Sustained Benefit of a Community and Professional Intervention to Increase Acute Stroke Therapy
Arch Intern Med, October 13, 2003; 163(18): 2198 - 2202.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
A. W. Wojner, L. Morgenstern, A. V. Alexandrov, D. Rodriguez, D. Persse, and J. C. Grotta
Paramedic and Emergency Department Care of Stroke: Baseline Data From a Citywide Performance Improvement Study
Am. J. Crit. Care., September 1, 2003; 12(5): 411 - 417.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
F. Harraf, A. K Sharma, M. M Brown, K. R Lees, R. I Vass, and L. Kalra
A multicentre observational study of presentation and early assessment of acute stroke
BMJ, July 6, 2002; 325(7354): 17 - 17.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
C. Ayala, J. B. Croft, K. J. Greenlund, N. L. Keenan, R. S. Donehoo, A. M. Malarcher, and G. A. Mensah
Sex Differences in US Mortality Rates for Stroke and Stroke Subtypes by Race/Ethnicity and Age, 1995-1998
Stroke, May 1, 2002; 33(5): 1197 - 1201.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
L. Derex, P. Adeleine, N. Nighoghossian, J. Honnorat, and P. Trouillas
Factors Influencing Early Admission in a French Stroke Unit
Stroke, January 1, 2002; 33(1): 153 - 159.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
L. B. Morgenstern, L. Staub, W. Chan, T. H. Wein, L. K. Bartholomew, M. King, R. A. Felberg, W. S. Burgin, J. Groff, S. L. Hickenbottom, et al.
Improving Delivery of Acute Stroke Therapy: The TLL Temple Foundation Stroke Project
Stroke, January 1, 2002; 33(1): 160 - 166.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
W.S. Burgin, L. Staub, W. Chan, PhD;, T.H. Wein, R.A. Felberg, J.C. Grotta, A.M. Demchuk, S.L. Hickenbottom, and L.B. Morgenstern
Acute stroke care in non-urban emergency departments
Neurology, December 11, 2001; 57(11): 2006 - 2012.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
K. R. Evenson, D. L. Morris, W. D. Rosamond, J. H. Brice, S. L. Huston, and E. M. Puckett
Addressing Healthy People 2010 Objectives for Stroke
Stroke, July 1, 2001; 32(7): 1692 - 1692.
[Full Text] [PDF]

Home page
 StrokeHome page
L. B. Morgenstern, L. Steffen-Batey, M. A. Smith, and L. A. Moye
Barriers to Acute Stroke Therapy and Stroke Prevention in Mexican Americans
Stroke, June 1, 2001; 32(6): 1360 - 1364.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
C. R. Lacy, D.-C. Suh, M. Bueno, and J. B. Kostis
Delay in Presentation and Evaluation for Acute Stroke : Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.)
Stroke, January 1, 2001; 32(1): 63 - 69.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
D. L. Morris, W. Rosamond, K. Madden, C. Schultz, and S. Hamilton
Prehospital and Emergency Department Delays After Acute Stroke : The Genentech Stroke Presentation Survey
Stroke, November 1, 2000; 31(11): 2585 - 2590.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
E. B. Schroeder, W. D. Rosamond, D. L. Morris, K. R. Evenson, and A. R. Hinn
Determinants of Use of Emergency Medical Services in a Population With Stroke Symptoms : The Second Delay in Accessing Stroke Healthcare (DASH II) Study
Stroke, November 1, 2000; 31(11): 2591 - 2596.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
T. H. Wein, L. Staub, R. Felberg, S. L. Hickenbottom, W. Chan, J. C. Grotta, A. M. Demchuk, J. Groff, L. K. Bartholomew, and L. B. Morgenstern
Activation of Emergency Medical Services for Acute Stroke in a Nonurban Population : The T.L.L. Temple Foundation Stroke Project
Stroke, August 1, 2000; 31(8): 1925 - 1928.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
L. B. Morgenstern, T. H. Wein, M. A. Smith, L. A. Moye, D. K. Pandey, and D. R. Labarthe
Comparison of stroke hospitalization rates among Mexican-Americans and non-Hispanic whites
Neurology, May 23, 2000; 54(10): 2000 - 2002.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
O. Fustinoni and J. Biller
Ethnicity and Stroke : Beware of the Fallacies
Stroke, May 1, 2000; 31(5): 1013 - 1015.
[Full Text] [PDF]

Home page
 StrokeHome page
T. H. Wein, M. A. Smith, and L. B. Morgenstern
Race/Ethnicity and Location of Stroke Mortality : Implications for Population-Based Studies
Stroke, August 1, 1999; 30(8): 1501 - 1505.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
S. E. Kasner, J. A. Chalela, J. M. Luciano, B. L. Cucchiara, E. C. Raps, M. L. McGarvey, M. B. Conroy, and A. R. Localio
Reliability and Validity of Estimating the NIH Stroke Scale Score from Medical Records
Stroke, August 1, 1999; 30(8): 1534 - 1537.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. Mines, S. Rosenzweig, J. F. Campa, J. L. Stolz, L. F. Palma, A. Villa, M. Bonacina, S. Paese, E. Omboni, D. L. Schriger, et al.
Reducing Treatment Delay and Improving Diagnostic Accuracy for Patients With Acute Stroke
JAMA, January 6, 1999; 281(1): 31 - 34.
[Full Text] [PDF]

Home page
 JWatch Women's HealthHome page
Stroke Care Slower for Women
Journal Watch Women's Health, November 1, 1998; 1998(1101): 16 - 16.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1998 by AAN Enterprises, Inc.