Sex-based differences in emergency department treatment times for acute ischaemic stroke: evidence from a large Italian cohort

Introduction Sex-related disparities in acute ischaemic stroke (AIS) care have been widely reported. However, evidence from Italy remains limited. We aimed to evaluate sex differences in access to revascularisation treatments (RTs) and key time performance indicators in a large Italian cohort. Patients and methods We conducted a single-centre, retrospective, observational study including all adults admitted to the emergency department of a comprehensive stroke centre in Rome between January 2015 and December 2022 for suspected stroke. Clinical and demographic characteristics, comorbidities, presenting symptoms, RTs and stroke care time metrics were collected. Multivariable logistic and linear regression models, as well as restricted cubic spline analyses, were used to assess sex-related differences in RTs and time indicators, adjusting for relevant confounders. Results Within the 9167 patients, 44.4% had AIS, and 48.2% were women. Among patients with AIS, women were older (P < .001), had higher NIHSS scores at onset (P < .001), a greater comorbidity burden (P < .001) and higher in-hospital mortality (P = .010). No significant sex differences were observed in intravenous thrombolysis and endovascular treatment administration rates. However, median door-to-needle time was 4 min longer in women than in men (P = .030). After adjustment, female sex was not significantly associated with RT administration or in-hospital mortality, but remained an independent predictor of longer DNT [adjusted β −8.242; 95% CI (−15.453 to −1.031); P = .025]. Discussion and conclusions Although access to RTs was comparable between sexes, women experienced longer DNT, indicating persistent in-hospital barriers to timely stroke care. These findings highlight the need for targeted interventions to achieve full equity in AIS management.