Gender based differences in acute stroke care in Michigan hospitals

Background: We sought to examine whether gender-based differences in acute stroke care occur in both Joint Commission (JC) certified and noncertified hospitals. Methods: 602 charts of patients with ischemic stroke were reviewed from five JC certified and five noncertified hospitals for gender differences in the prehospital factors, emergency department evaluation, in-hospital stroke care, discharge outcome and use of secondary prevention measures. Results: More women arrived via ambulance (63.1% women vs. 53.9% men, p = 0.025) while more men came by self-transportation (42.6% vs. 30%, p = 0.0016). There was no difference by gender for evaluation for thrombolytics (89.4% men vs. 85.9% women) or intravenous t-PA administered (3.5% men vs. 2.5% women, p = 0.82). More patients in JC certified centers were evaluated for thrombolysis than in noncertified centers. Delay in arrival was the commonest reason for not getting thrombolysis in both groups. More men than women had mild/resolving symptoms, had more interventional procedures, and better discharge outcome. More men were discharged on antithrombotics. Even after adjusting for age, gender differences were significant for arrival by ambulance, self transportation, mild/resolving symptoms, interventional procedures performed and marginally for good discharge outcome. Conclusion: There were significant gender differences in delivery of acute stroke care in Michigan hospitals even after adjustment for age differences. In spite of milder symptoms and less usage of emergency services, men received more aggressive stroke care with a tendency towards better discharge outcome. Going to a JC certified. center was a better predictor of consideration for thrombolytics than gender. (C) 2011 Elsevier B.V. All rights reserved.