Neighborhood-level variation in prehospital care of patients with suspected stroke in Rhode Island.

Abstract

This study aims to identify neighborhood-level inequities in prehospital stroke care, including EMS utilization and last known well (LKW) to ED presentation, in a small state with one large comprehensive stroke center. This was a retrospective observational study using 2 years of data (2020-2022) from Get With The Guidelines combined with data collected by a large hospital system in Rhode Island that includes a comprehensive stroke center (CSC), the Rhode Island emergency management system database, and 2020 census data. Census tract disadvantage was significantly associated with LKW to ED arrival times, with individuals from more disadvantaged neighborhoods presenting almost a full hour later than individuals from the least disadvantaged neighborhoods (56.9 min, 95% confidence interval 14.9-90.3 min). EMS use was the strongest predictor of LKW to ED arrival times, and the Latinx population was significantly less likely to utilize EMS compared to the White population. Understanding geographical inequities in stroke recognition and prehospital stroke care can help mitigate important socioeconomic and racial/ethnic disparities. In addition, geospatial analysis provides useful information for targeting intervention strategies to neighborhoods with the longest LKW to ED arrival times and lowest use of EMS.