ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2025
Precipitation, EMS use, and time to presentation of Acute Ischemic stroke in the get with the guidelines-stroke registry.
Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDelayed presentation to the hospital is a barrier for delivering acute stroke treatments. The effects of weather on delay are unstudied. We examined the relationship between precipitation and time to arrival nationwide.
methodsWe studied patients with acute ischemic stroke who presented at a Get With the Guidelines®-Stroke hospital from 2010-2019. The exposure variable was total daily precipitation on the day of presentation, obtained from the National Oceanic and Atmospheric Administration, and categorized as none (0 inches/day), mild (>0-1 inch/day), and major (>1 inch/day). The primary outcome was time to hospital arrival after stroke (in minutes). We conducted multivariate regression analysis, including analysis of interaction between precipitation level and EMS usage.
resultsIn ∼2.7 million patients, 50.7% were female and 38.6% were ≥75 years old. Median time to hospital arrival was 212 minutes in no precipitation, 219 minutes in mild precipitation, and 223 minutes in major precipitation. In adjusted analyses, compared to no precipitation, mild precipitation was associated with 4.63 minutes of delay [95% CI: (2.77, 6.49)]. Major precipitation was associated with 7.69 minutes of delay [95% CI: (2.86, 12.52)]. EMS usage improved arrival time overall, and there was an interaction with mild precipitation (-6.09 minutes [95% CI: (-9.79 to -2.39)]). However, there was no interaction with major precipitation (-2.72 minutes [95% CI: (-12.38 to 6.93)]).
conclusionPrecipitation was associated with delayed presentation to the hospital in acute stroke. Increased frequency of extreme weather calls for developing EMS strategies and infrastructure to support climate-ready stroke systems of care.
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