During 2014–2018, there was an average total of 138.58 million annual ED visits in the data set. Tables 1 includes the descriptive demographic and clinical characteristics of the patient cohort of each analysis with nationally representative estimates. Females and non-Hispanic whites represented approximately 60% of the cohort. Over half of patients within the cohort held public insurance. See Table 1 for other demographics such as race, insurance, and urban setting. The average DTP time ranged from 39 to 49 minutes, depending on the how stroke symptoms were defined, and most patients had DTP times > 10 minutes from the initial presentation (Table 2).
Table 1
Patient Characteristics (%)a
|
|
Narrow Sx, Any CC
|
Narrow Sx, Only CC
|
Broad Sx, Any CC
|
Broad Sx, Only CC
|
|
|
n = 3,316
|
n = 373
|
n = 7,677
|
n = 1,599
|
Triage level 1 or 2
|
|
23.27
|
16.03
|
20.35
|
17.12
|
DTP time
|
minutes
(S.E.)
|
48.60
(3.25)
|
39.20
(4.45)
|
44.03
(2.30)
|
39.90
(3.03)
|
Age
|
< 40
|
30.57
|
24.70
|
36.85
|
37.89
|
40–64
|
41.25
|
34.69
|
37.06
|
33.43
|
65+
|
28.18
|
40.61
|
26.09
|
28.59
|
Sex
|
Male
|
38.44
|
45.99
|
35.99
|
39.53
|
Female
|
61.56
|
54.01
|
64.01
|
60.47
|
Race
|
Non-Hispanic White
|
60.24
|
60.94
|
60.96
|
60.36
|
Black
|
22.01
|
18.55
|
22.50
|
22.74
|
Hispanic
|
14.36
|
16.16
|
13.38
|
14.09
|
Others
|
3.39
|
4.35
|
3.17
|
2.80
|
Insurance
|
No insurance
|
18.44
|
19.45
|
18.87
|
22.61
|
Private
|
28.42
|
26.77
|
25.81
|
23.09
|
Public
|
53.14
|
53.77
|
55.32
|
54.30
|
MSA
|
No
|
16.01
|
17.49
|
17.35
|
18.83
|
Yes
|
83.99
|
82.51
|
82.65
|
81.17
|
Ambulance arrival
|
No
|
79.30
|
74.65
|
77.29
|
67.52
|
Yes
|
20.70
|
25.35
|
22.71
|
32.48
|
Ambulance transfer from another facility
|
No
|
99.09
|
99.63
|
98.95
|
98.41
|
Yes
|
0.91
|
0.37
|
1.05
|
1.59
|
Heart rate
|
60–99
|
75.80
|
75.54
|
72.71
|
72.69
|
< 60
|
8.55
|
15.34
|
8.26
|
12.09
|
>=100
|
15.65
|
9.12
|
19.03
|
15.22
|
Systolic BP
|
< 140
|
53.29
|
43.11
|
57.33
|
56.45
|
140–179
|
38.59
|
42.68
|
34.94
|
34.57
|
>=180
|
8.12
|
14.21
|
7.73
|
8.98
|
Pulse Oximeter
|
>=90%
|
98.15
|
92.94
|
97.86
|
96.77
|
< 90%
|
1.85
|
7.06
|
2.14
|
3.23
|
Prior ED visit < 72 hrs ago
|
No
|
96.03
|
95.84
|
95.97
|
96.96
|
Yes
|
3.97
|
4.16
|
4.03
|
3.04
|
Medical Hx
|
Cancer
|
4.59
|
6.05
|
4.48
|
3.53
|
Stroke
|
10.96
|
14.55
|
8.29
|
9.92
|
Renal disease
|
4.85
|
6.08
|
4.65
|
3.19
|
CHF
|
4.93
|
4.53
|
5.44
|
4.63
|
CAD
|
13.08
|
14.89
|
10.91
|
10.47
|
DM
|
18.98
|
21.55
|
17.88
|
17.80
|
Thromboembolism
|
1.59
|
0.37
|
1.83
|
1.15
|
Hyperlipidemia
|
18.47
|
16.30
|
15.69
|
15.08
|
Hypertension
|
43.71
|
46.00
|
40.24
|
36.56
|
a The percentages are proportions representative of the EDs in the US, taking into account the complex sampling design.
MSA: Metropolitan Statistical Area; Sx: symptoms; CC: chief complaint; DTP: Door-to-provider; S.E.: standard error; CHF: congestive heart failure; CAD: coronary artery disease; DM: diabetes mellitus
Table 2
Distribution of Door-to-Provider Time by Race (%) a
|
|
≤ 10 mins
|
11–20 mins
|
21–30 mins
|
31–60 mins
|
61–120 mins
|
> 120 mins
|
p-value
|
Narrow Sx, Any CC
|
NHW
|
29.94
|
18.32
|
9.72
|
14.94
|
10.06
|
17.01
|
0.63
|
Black
|
28.96
|
15.13
|
10.12
|
13.98
|
10.75
|
21.06
|
Hispanic
|
31.78
|
14.77
|
7.34
|
16.17
|
9.79
|
20.15
|
Others
|
27.71
|
12.60
|
12.09
|
18.98
|
4.99
|
23.62
|
Narrow Sx, Only CC
|
NHW
|
31.43
|
9.07
|
8.62
|
15.61
|
8.86
|
26.41
|
0.36
|
Black
|
23.80
|
13.43
|
19.89
|
14.80
|
9.74
|
18.34
|
Hispanic
|
39.70
|
10.95
|
3.71
|
7.53
|
10.05
|
28.06
|
Others
|
54.12
|
12.42
|
19.71
|
2.65
|
0.00
|
11.10
|
Broad Sx, Any CC
|
NHW
|
30.86
|
18.76
|
10.57
|
15.73
|
8.57
|
15.51
|
0.01
|
Black
|
28.34
|
17.12
|
9.78
|
13.16
|
10.69
|
20.91
|
Hispanic
|
30.91
|
14.23
|
6.82
|
17.08
|
11.84
|
19.12
|
Others
|
32.54
|
14.71
|
8.85
|
20.57
|
6.91
|
16.41
|
Broad Sx, Only CC
|
NHW
|
33.85
|
15.76
|
9.22
|
14.74
|
7.54
|
18.89
|
0.03
|
Black
|
29.61
|
21.87
|
12.28
|
8.61
|
9.46
|
18.17
|
Hispanic
|
32.81
|
14.74
|
2.58
|
22.83
|
9.76
|
17.28
|
Others
|
39.04
|
11.39
|
11.60
|
14.56
|
1.42
|
21.99
|
a The percentages are proportions representative of the EDs in the US, taking into account the complex sampling design.
Sx: symptoms; CC: chief complaint; NHW: Non-Hispanic whites
Narrow Definition, Any of the Chief Complaints Was Stroke-Related
We identified a total of 4.40 million average annual ED visits under this category. This number of visits accounted for 3.16% of the total ED visits that occurred in the US. A triage level of 1 or 2 was present in 23.27% of the visits, with details by race/ethnicity illustrated in Fig. 1. The average DTP time was 48.60 (95% CI: 42.22–54.99) minutes, with details by race/ethnicity shown in Fig. 2. Of these visits, 29.91% had DTP time ≤ 10 minutes, and 19.92% had a DTP time between 11–20 minutes. We observed a DTP time of > 2 hours in 18.58% of the visits. A diagnosis of stroke or TIA was made in 5.71% of these visits, with details by race/ethnicity shown in Fig. 3. We did not identify statistically significant racial disparities in the triage level or DTP time in the bivariate analyses. Consequently, we did not perform additional multivariate analyses. Non-Hispanic Whites had significantly higher proportions of stroke diagnosis than the other groups (p = 0.019).
Narrow Definition, Only Stroke-Related Symptoms in Chief Complaints
We identified a total of 0.51 million average annual ED visits under this category, and this total accounted for 0.36% of all ED visits in the US. A triage level 1 or 2 was present in 16.03% of the visits, as illustrated in Fig. 1. The average DTP time was 39.20 (95% CI: 30.47–47.94) minutes, as shown in Fig. 2. Of these visits, 32.34% had DTP time ≤ 10 minutes, and 10.33% had DTP time between 11–20 minutes. We observed a DTP time of > 2 hours in 24.51% of the visits. A diagnosis of stroke or TIA in the ED was associated with 9.36% of these visits, as shown in Fig. 3. A bivariate analysis did not demonstrate statistically significant racial disparities in the triage level, DTP time or diagnosis of stroke/TIA. Consequently, no further multivariate analyses were performed.
Broad Definition, Any of the Chief Complaints Was Stroke-Related
We identified a total of 10.24 million average annual ED visits under this category, which accounted for 7.39% of the total ED visits in the US. A triage level 1 or 2 was present in 20.35% of the visits, as illustrated in Fig. 1. The average DTP time was 44.03 (95% CI: 39.51–48.56) minutes, as shown in Fig. 2. Of these visits, 30.35% had DTP time ≤ 10 minutes, and 17.66% had DTP time between 11–20 minutes. We observed a DTP time of > 2 hours in 17.24% of the visits. A diagnosis of stroke or TIA was present in 3.32% of these visits, as shown in Fig. 3. We did not identify statistically significant racial disparities in the triage level. However, blacks had a statistically significantly longer DTP time with the difference of 15.88 minutes (54.07 vs. 38.19 minutes; p = 0.007, 95% CI: 4.29–27.48) when compared to non-Hispanic whites. Hispanics also had a significantly longer DTP time than non-Hispanic Whites by 14.77 minutes (p = 0.011, 95% CI: 3.37–26.16). In the multivariate analyses, controlling for other sociodemographic characteristics and clinical factors, blacks had an average of 11.97 minutes longer DTP time than non-Hispanic whites (p = 0.030, 95% CI: 1.17–22.77), and Hispanic had an average of 11.84 minutes longer DTP time than non-Hispanic whites (p = 0.042, 95% CI: 0.43–23.24). Lastly, non-Hispanic whites were significantly more frequently diagnosed with a stroke/TIA than racial and ethnic minority groups (p = 0.045) in the bivariate analysis. The proportions of stroke/TIA diagnosis for non-Hispanic white, black, Hispanic and others were 3.86%, 2.37%, 2.88% and 1.64%, respectively.
Broad Definition, Only Stroke-Related Symptoms in Chief Complaints
We identified a total of 2.23 million average annual ED visits under this category, which accounted for 1.61% of the total ED visits in the US. A triage level of 1 or 2 was present in 17.12% of the visits, as illustrated in Fig. 1. The average DTP time was 39.90 (95% CI: 33.95–45.85) minutes, as shown in Fig. 2. Of these visits, 32.89% had DTP time ≤ 10 minutes, and 16.88% had DTP time between 11–20 minutes. We observed a DTP time of > 2 hours in 18.59% of the visits. A diagnosis of stroke or TIA was present in 5.01% of these visits, as shown in Fig. 3. We did not identify statistically significant racial disparities in the triage level or DTP time in the bivariate analyses. Consequently, we did not perform additional multivariate analyses. However, it should be noted that although there were no racial/ethnic differences in the mean DTP, the differences in the distribution were statistically significant (p = 0.03) as shown in Table 2.