Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Mar 15;13(1):31.
doi: 10.3390/medsci13010031.

Association Between Sociodemographic Disparities and Door to Computerized Tomography Time in Patients with Acute Ischemic Stroke Across COVID-19 Periods in the Emergency Department: A Multi-Center Cohort Study

Yu-Lin Hsieh  1   2 , Ching-Fang Tiffany Tzeng  3 , Maha Khan  4   5 , Andrew Shedd  4   5 , Thomas Damrow  4 , Dahlia Hassani  4   5 , Matthew Danley  6 , Jaydeep Shah  6 , Jennifer Walker  4   5 , Eric H Chou  4   5
Affiliations
Multicenter Study

Association Between Sociodemographic Disparities and Door to Computerized Tomography Time in Patients with Acute Ischemic Stroke Across COVID-19 Periods in the Emergency Department: A Multi-Center Cohort Study

Yu-Lin Hsieh et al. Med Sci (Basel). .

Abstract

Introduction: Stroke is the fifth leading cause of death and long-term disability in the United States. The current guideline for stroke management includes a 25 min timeframe from door-to-computed tomography time (DTCT). However, sociodemographic backgrounds may impact the DTCT in acute stroke patients.

Methods: This was a retrospective, multicenter, cohort study between January 2018 and August 2022 throughout North Texas. The primary endpoint was DTCT ≤ 25 min upon arrival to hospital for all patients suspected of acute ischemic stroke.

Results: During the study period, a total of 23,364 patients were included. Only 4468 patients (19.1%) had DTCT times less than or equal to 25 min, and 16,464 patients (70.5%) had DTCT times more than 25 min. In our cohort, Black (OR 1.35; 95% CI 1.23-1.49) and Asian patients (OR 1.33; 95% CI 1.01-1.74) were more likely to have DTCT > 25 min compared to White patients. Hispanic patients (OR 1.20; 95% CI 1.07-1.34) were more likely to have DTCT > 25 min compared to non-Hispanics. Patients presenting during the COVID (OR 1.45; 95% CI 1.34-1.57) and post-COVID period (OR 1.46; 95% CI 1.30-1.65) were more likely to have DTCT > 25 min compared to the pre-COVID period.

Conclusions: We demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population and an increase in DTCT time after the start of COVID-19, which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time.

Keywords: COVID; acute ischemic stroke; door-to-CT time; sociodemographic.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of patient selection.
See this image and copyright information in PMC

References

    1. Renedo D., Acosta J.N., Leasure A.C., Sharma R., Krumholz H.M., de Havenon A., Alahdab F., Aravkin A.Y., Aryan Z., Bärnighausen T.W., et al. Burden of Ischemic and Hemorrhagic Stroke Across the US from 1990 to 2019. JAMA Neurol. 2024;81:394–404. doi: 10.1001/jamaneurol.2024.0190. - DOI - PMC - PubMed
    1. Yang Q., Tong X., Schieb L., Coronado F., Merritt R. Stroke Mortality Among Black and White Adults Aged ≥35 Years Before and During the COVID-19 Pandemic—United States, 2015–2021. MMWR Morb. Mortal. Wkly. Rep. 2023;72:431–436. doi: 10.15585/mmwr.mm7216a4. - DOI - PMC - PubMed
    1. Kelly A.G., Hellkamp A.S., Olson D., Smith E.E., Schwamm L.H. Predictors of rapid brain imaging in acute stroke: Analysis of the Get with the Guidelines-Stroke program. Stroke. 2012;43:1279–1284. doi: 10.1161/STROKEAHA.111.626374. - DOI - PubMed
    1. Association A.H. Get with the Guideline-Stroke. [(accessed on 13 February 2025)]. Available online: https://www.heart.org/en/professional/quality-improvement/get-with-the-g....
    1. Jauch E.C., Saver J.L., Adams H.P., Jr., Bruno A., Connors J.J., Demaerschalk B.M., Khatri P., McMullan P.W., Jr., Qureshi A.I., Rosenfield K., et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947. doi: 10.1161/STR.0b013e318284056a. - DOI - PubMed

Publication types

LinkOut - more resources