• Vaughan Sarrazin Mary M Department of Internal Medicine, University of Iowa, Iowa City, Iowa. Electronic address: mary-vaughan-sarrazin@uiowa.edu., Kaustubh Limaye, Edgar A Samaniego, Sami Al Kasab, Ali Sheharyar, Sudeepta Dandapat, Waldo R Guerrero, David M Hasan, Santiago Ortega-Gutierrez, Colin P Derdeyn, James C Torner, Angel Chamorro, and Enrique C Leira.
• Department of Internal Medicine, University of Iowa, Iowa City, Iowa. Electronic address: mary-vaughan-sarrazin@uiowa.edu.
• J Stroke Cerebrovasc Dis. 2019 Mar 1; 28 (3): 550-556.

Background And PurposeMechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients.MethodsAcute ischemic stroke patients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders.ResultsA total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019).DiscussionOur findings suggest there is a disparity in the use of HEMS in Hispanic stroke patients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.Copyright © 2018. Published by Elsevier Inc.

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