Improved stroke detection in women will save lives and millions in health care costs, new study finds

A new study has found that improving pre-hospital stroke identification accuracy in women to match that of men will lead to significant health benefits and cost savings for all Australians.

Published in the Medical Journal of Australia, the study sought to estimate the long-term gains in life years and quality-adjusted life years (QALYs) and the cost savings that could be achieved if ischemic stroke was identified in women with the same level of accuracy received by men, versus the status quo.

Western Sydney University lead researcher, Associate Professor Lei Si from the School of Health Sciences and the Translational Health Research Institute said that women are 11% less likely than men to be correctly identified as having a stroke by emergency medical staff.

The study used a health economic modeling approach to quantify the health and economic cost of the missed opportunity to diagnose women as accurately men are currently diagnosed, revealing that it costs the Australian public millions.

“Our study shows that if we could match the accuracy with which men’s strokes are identified, women would gain an average of 51 extra days of life and nearly a month of life in perfect health—all while saving nearly $3,000 in health care costs per patient,” said Associate Professor Si, corresponding author of the study.

“At the national level, this could translate to over 250 additional life years, 144 extra quality-adjusted life years, and $5.4 million in health care savings each year.”

“This is an important finding because accurate and timely pre-hospital stroke identification increases the chance of receiving intravenous thrombolysis (IVT) within the critical 60-minute treatment window, which significantly improves patient health outcomes and saves medical costs.”

Jordan Springs resident, Kelly Ryan, was only 32 years old when she suffered a stroke in September 2020 in the cerebellum posterior part of her brain after a chiropractic session left her with a bilateral vertebral artery dissection.

At the time, her symptoms were loss of balance, blurred double vision, vomiting, and an ice-pick style headache. She was incorrectly diagnosed with vertigo and a migraine.

FAST is the current acronym commonly used in identifying a stroke, which includes noticing changes in a patient’s Face and facial drooping, Arm weakness, Speech difficulty, and acting in a Timely manner to receive treatment for the best outcomes.

However, the FAST protocol does not capture all types of strokes and overlooks other stroke symptoms including changes in balance, eye and vision changes, and nausea that Kelly was experiencing.

While both men and women can experience the classic FAST-positive stroke symptoms, women are more likely to present with additional, sometimes subtle, symptoms that can easily be overlooked.

“Initially I was shrugged off as just having a migraine and vertigo as I was not FAST-positive, it took six hours to get a CT scan, and I was sent home with an outpatient appointment for an MRI a week later. It took a total of two weeks to be diagnosed as having a stroke,” said Kelly.

“Had my stroke been recognized early on, I may have been a candidate for the clot-busting drug, which could have stopped or at least reduced the damage of the stroke.”

“People all around the world have been through the same thing, sometimes even waiting months for someone to take them seriously, as medical staff are so focused on someone being FAST-positive to diagnose stroke, people like me are falling through the cracks.”

The study, “Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study,” was led by a team of researchers from Western Sydney University, UNSW Sydney, and The George Institute for Global Health Australia and the U.K.

A new study has found that improving pre-hospital stroke identification accuracy in women to match that of men will lead to significant health benefits and cost savings for all Australians.

Published in the Medical Journal of Australia, the study sought to estimate the long-term gains in life years and quality-adjusted life years (QALYs) and the cost savings that could be achieved if ischemic stroke was identified in women with the same level of accuracy received by men, versus the status quo.

Western Sydney University lead researcher, Associate Professor Lei Si from the School of Health Sciences and the Translational Health Research Institute said that women are 11% less likely than men to be correctly identified as having a stroke by emergency medical staff.

The study used a health economic modeling approach to quantify the health and economic cost of the missed opportunity to diagnose women as accurately men are currently diagnosed, revealing that it costs the Australian public millions.

“Our study shows that if we could match the accuracy with which men’s strokes are identified, women would gain an average of 51 extra days of life and nearly a month of life in perfect health—all while saving nearly $3,000 in health care costs per patient,” said Associate Professor Si, corresponding author of the study.

“At the national level, this could translate to over 250 additional life years, 144 extra quality-adjusted life years, and $5.4 million in health care savings each year.”

“This is an important finding because accurate and timely pre-hospital stroke identification increases the chance of receiving intravenous thrombolysis (IVT) within the critical 60-minute treatment window, which significantly improves patient health outcomes and saves medical costs.”

Jordan Springs resident, Kelly Ryan, was only 32 years old when she suffered a stroke in September 2020 in the cerebellum posterior part of her brain after a chiropractic session left her with a bilateral vertebral artery dissection.

At the time, her symptoms were loss of balance, blurred double vision, vomiting, and an ice-pick style headache. She was incorrectly diagnosed with vertigo and a migraine.

FAST is the current acronym commonly used in identifying a stroke, which includes noticing changes in a patient’s Face and facial drooping, Arm weakness, Speech difficulty, and acting in a Timely manner to receive treatment for the best outcomes.

However, the FAST protocol does not capture all types of strokes and overlooks other stroke symptoms including changes in balance, eye and vision changes, and nausea that Kelly was experiencing.

While both men and women can experience the classic FAST-positive stroke symptoms, women are more likely to present with additional, sometimes subtle, symptoms that can easily be overlooked.

“Initially I was shrugged off as just having a migraine and vertigo as I was not FAST-positive, it took six hours to get a CT scan, and I was sent home with an outpatient appointment for an MRI a week later. It took a total of two weeks to be diagnosed as having a stroke,” said Kelly.

“Had my stroke been recognized early on, I may have been a candidate for the clot-busting drug, which could have stopped or at least reduced the damage of the stroke.”

“People all around the world have been through the same thing, sometimes even waiting months for someone to take them seriously, as medical staff are so focused on someone being FAST-positive to diagnose stroke, people like me are falling through the cracks.”

The study, “Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study,” was led by a team of researchers from Western Sydney University, UNSW Sydney, and The George Institute for Global Health Australia and the U.K.