ArticleStroke2024
Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study.
Article in Stroke, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07207330 (Stroke Code), which is not on this map. Cited by 6 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Stroke Code: an Observational Cross-sectional Trial in Hospitals From Villavicencio, Colombia
Who cites it
6 citing papers in PubMed.
- Article
- Effect of Prehospital Time on Door-to-Computed Tomography Time in Acute Ischemic Stroke: A Multicenter Study.Brain and behavior · 2026Observational
- Neighborhood Deprivation, Antibiotic Prescribing Concordance, and 30-Day Outcomes After Emergency Department Encounters in Older Adults.Open forum infectious diseases · 2026Article
- Social Vulnerability and Out-of-Hospital Identification of Neurologic Emergencies.Annals of emergency medicine · 2026Article
- Race- and Ethnicity-Specific Hospital Arrival and Emergency Medicine Service Activation Times by US State for Ischemic Stroke.Journal of the American Heart Association · 2026Article
- Precipitation, EMS use, and time to presentation of Acute Ischemic stroke in the get with the guidelines-stroke registry.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
backgroundDelays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability.
methodsWe studied patients with ischemic stroke who arrived by emergency medical services in 2015 to 2017 from the American Heart Association Get With The Guidelines-Stroke registry. The primary outcome was time to hospital arrival after stroke (in minutes), beginning at last known well in most cases. Using Geographic Information System mapping, we displayed the geography of delay. We then used Cox proportional hazard models to study the relationship between community-level factors and arrival time (adjusted hazard ratios [aHR] <1.0 indicate delay). The primary exposure was the social vulnerability index (SVI), a metric of social vulnerability for every ZIP Code Tabulation Area ranging from 0.0 to 1.0.
resultsOf 750 336 patients, 149 145 met inclusion criteria. The mean age was 73 years, and 51% were female. The median time to hospital arrival was 140 minutes (Q1: 60 minutes, Q3: 458 minutes). The geospatial map revealed that many zones of delay overlapped with socially vulnerable areas (https://harvard-cga.maps.arcgis.com/apps/webappviewer/index.html?id=08f6e885c71b457f83cefc71013bcaa7). Cox models (aHR, 95% CI) confirmed that higher SVI, including quartiles 3 (aHR, 0.96 [95% CI, 0.93-0.98]) and 4 (aHR, 0.93 [95% CI, 0.91-0.95]), was associated with delay. Patients from SVI quartile 4 neighborhoods arrived 15.6 minutes [15-16.2] slower than patients from SVI quartile 1. Specific SVI themes associated with delay were a community's socioeconomic status (aHR, 0.80 [95% CI, 0.74-0.85]) and housing type and transportation (aHR, 0.89 [95% CI, 0.84-0.94]).
conclusionsThis map of acute stroke presentation times shows areas with a high incidence of delay. Increased social vulnerability characterizes these areas. Such places should be systematically targeted to improve population-level stroke presentation times.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.