Diagno stic evaluation for patients with ischemic stroke: Are there sex differences?

Background and Purpose: Differences in the management of women and men with acute coronary symptoms are well documented, but relatively little is known about practices for patients with ischemic stroke. We sought to determine whether there are sex-associated differences in the utilization of diagnostic tests for ischemic stroke patients treated at academic hospitals in the United States. Methods: Medical records were abstracted for consecutive ischemic stroke patients admitted to 32 US academic medical centers from January through June, 2004, as part of the University HealthSystem Consortium Ischemic Stroke Benchmarking Project. We compared the utilization rates of diagnostic tests including neuroimaging (CT or MRI), electrocardiogram (ECG), ultrasound of the carotid arteries, and echocardiography (transthoracic or transesophageal) for women and men. Multivariate logistic regression was used to test for sex differences with adjustment for potential confounders. Results: The study included 1,256 ischemic stroke patients (611 women; 645 men; mean age 66.6 ± 14.6 years; 56% white). There were no differences between women and men in the use of neuroimaging (odds ratio, OR = 1.37; 95% confidence interval, CI = 0.58-3.24), ECG (OR = 1.00, 95% CI = 0.70-1.44), carotid artery ultrasound (OR = 0.93, 95% CI = 0.72-1.21) or echocardiography (OR = 0.70, 95% CI = 0.70-1.22). The results were similar after covariate adjustment. Conclusions: Women and men admitted to US academic hospitals receive comparable diagnostic evaluations, even after adjusting for sociodemographic and clinical factors.