The Stockholm Stroke Triage System (SSTS), implemented 2017, combines teleconsultation with testing for moderate-to-severe unilateral hemiparesis. Sex differences in clinical characteristics among acute ischemic stroke (AIS) patients may affect triage accuracy, however this has not been evaluated in SSTS. We aimed to determine whether there are sex differences in triage accuracy of SSTS to predict large artery occlusion (LAO) stroke and endovascular thrombectomy (EVT), and whether characteristics differ between men and women undergoing “code stroke” ambulance transport.
This retrospective observational study analyzed data collected October 2017-October 2018. We included 2905 patients, transported by first-priority ground ambulance to a Stockholm Region hospital, with acute stroke suspected by an ambulance nurse. Exclusion criteria were private or helicopter transport, onset outside Stockholm, or in-hospital stroke. We compared sensitivity, specificity, positive and negative predictive values, and overall accuracy between sexes. Pearson’s Chi2 and Mann-Whitney U were used for categorical and continuous variables.
No significant sex differences in SSTS predictive performance for LAO or EVT were found, overall accuracy for LAO 87.3% in women versus 86.7% in men. Women were median 4 years older (P<.001) and more frequently had stroke mimics (46.2% vs 41.8%, P=.016). Women more commonly had decreased level of consciousness (14.0% vs 10.2%, P=.005) and severe motor symptoms (2.0-6.0 more %-points, P=.003-.044), and less commonly had limb ataxia (7.2% vs 9.7%, P=.037).
Despite sex differences in clinical characteristics among patients undergoing ambulance transport due to suspected stroke, SSTS had equally good predictive performance for LAO stroke and EVT among men and women.