Demographic Analysis of Patients Diagnosed with Cerebral Infarction in a Rural Critical Access Hospital
Abstract
Background: Ischemic cerebral infarction is a pathology where treatment is time-sensitive: 4.5 hours for thrombolysis and 24 hours for thrombectomy. Hispanic populations have previously been found to be less likely to present to the emergency department (ED) within this window. El Centro Regional Medical Center (ECRMC), a rural, border hospital in southeastern California, serves a predominantly Hispanic population. This study evaluated demographics and presentation times for patients with ischemic cerebral infarction presenting to ECRMC to better understand these healthcare disparities.
Methods: This retrospective observational study queried electronic records of ED patients diagnosed with ischemic stroke from 7/1/23–6/30/24. Data collected included age, gender, ethnicity, comorbidities (diabetes, heart disease, obesity, chronic kidney disease), symptom onset, ED arrival time, National Institutes of Health Stroke Scale/Score (NIHSS), and treatments (thrombolysis, thrombectomy, or transfer).
Results: Over this period, 127 patients presented to this ED with ischemic stroke: 56.7% male, 86.6% Hispanic, median age 69, and median NIHSS 5. Rates of comorbidities were high (79.5% heart disease, 40.9% diabetes, 33.9% obesity). The median time to arrival exceeded 6 hours. 15 patients had symptom onset in Mexico. 38.6% arrived within the thrombolysis window; 70.1% within the thrombectomy window. 9.4% received thrombolytics, 5.5% were transferred for thrombectomy, and 13.4% for other reasons.
Conclusions: In this primarily Hispanic rural ED population, most patients with cerebral ischemia presented outside the thrombolysis window. With increased risk factors and delays in presentation, efforts are needed to address healthcare disparities in this population.