• Prasanthi Govindarajan, Benjamin T Friedman, James Q Delgadillo, David Ghilarducci, Lawrence J Cook, Barbara Grimes, Charles E McCulloch, and S Claiborne Johnston.
• The Department of Emergency Medicine, University of California at San Francisco, San Francisco, CA.
• Acad Emerg Med. 2015 Mar 1; 22 (3): 264272264-72.

ObjectivesThe objective of this study was to examine prehospital provider recognition of stroke by race and sex.MethodsDiagnoses at emergency department (ED) and hospital discharge from a statewide database in California were linked to prehospital diagnoses from an electronic database from two counties in Northern California from January 2005 to December 2007 using probabilistic linkage. All patients 18 years and older, transported by ambulances (n = 309,866) within the two counties, and patients with hospital-based discharge diagnoses of stroke (n = 10,719) were included in the study. Logistic regression was used to analyze the independent association of race and sex with the correct prehospital diagnosis of stroke.ResultsThere were 10,719 patients discharged with primary diagnoses of stroke. Of those, 3,787 (35%) were transported by emergency medical services providers. Overall, 32% of patients ultimately diagnosed with stroke were identified in the prehospital setting. Correct prehospital recognition of stroke was lower among Hispanic patients (odds ratio [OR] = 0.77, 95% confidence interval [CI] 0.61 to 0.96), Asians (OR = 0.66, 95% CI 0.55 to 0.80), and others (OR = 0.71, 95% CI = 0.53 to 0.94), when compared with non-Hispanic whites, and in women compared with men (OR = 0.82, 95% CI = 0.71 to 0.94). Specificity for recognizing stroke was lower in females than males (OR = 0.84, 95% CI = 0.78 to 0.90).ConclusionsSignificant disparities exist in prehospital stroke recognition.© 2015 by the Society for Academic Emergency Medicine.

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