{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:36:27Z","timestamp":1783132587762,"version":"3.54.6"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Delayed hospital arrival after 4.5 hours of stroke onset excludes patients from intravenous thrombolytic therapy. In the United States, prehospital triage is regulated by each state. Understanding race\u2010 and ethnicity\u2010specific prehospital delays in each state could guide targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This cross\u2010sectional study examined adult patients treated at the GWTG (Get With The Guidelines)\u2010Stroke participating hospitals from January 2021 to August 2023 for acute ischemic stroke. The outcomes, including onset\u2010to\u2010arrival &gt;4.5 hours, onset\u2010to\u2010911 call &gt;2.5 hours, and 911 call\u2010to\u2010arrival &gt;1 hour by race and ethnicity and state, were examined using multivariable logistic regression analysis adjusting for patient and hospital\u2010level characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">The study included 691\u2009689 patients with a median age of 71\u2009years and 48.6% women. Compared with White patients, risk\u2010adjusted odds of onset\u2010to\u2010arrival &gt;4.5 hours were higher in Asian patients (1.24 [95% CI, 1.20\u20131.28]), Black patients (1.18 [95% CI, 1.16\u20131.19]), and Hispanic patients (1.10 [95% CI, 1.07\u20131.12]); onset\u2010to\u2010911 call &gt;2.5 hours was higher among Black patients (1.21 [95% CI, 1.16\u20131.26]); and 911 call\u2010to\u2010arrival &gt;1 hour was lower among Asian (0.55 [95% CI, 0.49\u20130.63]), Black patients (0.67 [95% CI, 0.62\u20130.72]), and Hispanic patients (0.69 [95% CI, 0.63\u20130.75]). Relative to Texas, which has the highest racial and ethnic diversity index, the odds of onset\u2010to\u2010arrival &gt;4.5 hours were higher in 20 states for non\u2010White patients and 9 states for White patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Delayed hospital arrivals are more prevalent among Asian, Black, and Hispanic patients, but emergency medicine service transportation times are shorter, suggesting the need for culturally tailored community stroke education. A few states have exceedingly high delayed arrival, highlighting an opportunity to improve state\u2010wide stroke readiness and emergency medicine service triage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.041674","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T10:22:17Z","timestamp":1767090137000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Race\u2010 and Ethnicity\u2010Specific Hospital Arrival and Emergency Medicine Service Activation Times by US State for Ischemic Stroke"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8345-6470","authenticated-orcid":false,"given":"Shumei","family":"Man","sequence":"first","affiliation":[{"name":"Neurological Institute, Cleveland Clinic","place":["Cleveland, 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