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Abstract Details

Gender Disparities in the Neurologic Management of Acute Stroke at a Military Treatment Facility
Cerebrovascular Disease and Interventional Neurology
P3 - Poster Session 3 (12:00 PM-1:00 PM)
4-020
To assess the potential impact of implicit bias in acute stroke care based on gender disparities in alert-to-needle times.
Women are an at-risk population for healthcare disparities.  From a neurological standpoint, women are less likely to receive acute stroke interventions and more likely to experience in-hospital delays when they do. Many factors have been implicated as contributing to healthcare disparities, including socioeconomic status and access to care. However, all patients treated at military treatment facilities have equal access to care regardless of their socioeconomic status. There is a growing body of literature identifying physician implicit bias as a significant barrier to healthcare equity.
A retrospective review of all stroke alerts which resulted in thrombolytic administration at San Antonio Military Medical Center from 2013 to 2017.  Alert-to-needle times were reviewed along with gender and NIH stroke scale scores. A nonparametric comparison using the Wilcoxon method was used to determine if there was a difference in alert-to-needle times based on gender.
A total of 87 cases were reviewed (47 men and 40 women). There was a statistically significant difference in alert-to-needle times between men and women with median alert-to-needle times being 49 (35,67) minutes for men and 59 (48,87) minutes for women (p=0.0305). There was no statistically significant difference in NIHSS between men and women.
These findings are consistent with previous studies showing gender disparities in acute stroke care. Alert-to-needle times may be a marker for implicit bias in neurologists as they eliminate the factor of stroke symptom recognition by non-neurologists. All patients were eligible for care within the military health system, minimizing the confounding effects of access and socioeconomic status.  Further prospective study is needed to definitively determine the cause of these observed disparities and to identify effective interventions.
Authors/Disclosures
Morgan Jordan, DO
PRESENTER 		Dr. Jordan has nothing to disclose.
Jeffrey C. McClean II, MD, FAAN (San Antonio Military Medical Center) Dr. McClean has or had stock in Tesla.Dr. McClean has or had stock in Netflix. An immediate family member of Dr. McClean has or had stock in Nike.Dr. McClean has received personal compensation in the range of $0-$499 for serving as a Committee Member with 好色先生.