Abstract TP361: The Association Between Socioeconomic Factors And Arrival Time To Emergency Departments After Stroke - The T3 Trial


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Abstract

Background: Socio-economic factors (SES) are associated with mortality, morbidity and access to health services. For optimal outcomes following stroke, it is critical that patients present to Emergency Departments (ED) with minimal delay after the onset of stroke symptoms.Purpose: To identify the relationship between residential postcode-based Socio-Economic Indexes For Areas (SEIFA), which ranks geographical areas in terms of relative socioeconomic advantage and disadvantage, and time to ED presentation after the onset of stroke symptoms.Methods: We used data from the pre-implementation cohort of the Triage, Treatment and Transfer of patients with stroke in ED’s (T3 trial) - a cluster randomized controlled trial conducted in 26 Hospitals in three states and one territory in Australia. SEIFA index scores were categorised into tertiles. A multivariable Cox regression modeled the relationship between SEIFA groups and time to ED presentation from symptom onset, adjusting for highest education level, age, sex, modified Rankin Scale (mRS), stroke severity and correlation of arrival time within hospitals using the cluster Huber-White sandwich estimator.Results: Of 689 patients, time to arrival was known for 669 (97%). Median arrival time was 2 hours (hrs) (Interquartile range (IQR) 5.5, range 0.05-46). Median arrival time for patients in the lowest SEIFA group was 3 hrs (IQR 6.5, range 0.05-46) compared to 2 hrs (IQR 3.5, range 0.5-38) and 2.5 hrs (IQR 6, range 0.5-26) in those in the middle and higher SEIFA strata, respectively, p=0.2. Multivariable analysis showed that older age (Hazard ratio (HR); 1.56, 95% Confidence interval (CI): 1.14-2.13), female sex (HR; 1.15, 95% CI: 1.03-1.28), moderate or severe stroke severity (HR; 1.44, 95% CI: 1.08-1.92) and middle SEIFA level (HR; 1.29, 95% CI: 1.04-1.59) were all significantly associated with longer time to ED presentation. A disability mRS score of 2 or more (HR; 0.74, 95% CI: 0.58-0.93) was inversely associated with the time to ED presentation, with shorter time to ED presentation observed with increasing disability.Conclusions: Targeted education for people with stroke symptoms and the importance of getting to hospital rapidly may help to reduce arrival time to ED and access to critical treatments.

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