Background 

In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change.

Purpose 

We aimed to (1) compare prehospital delay times—the time from symptom onset to hospital arrival—between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex.

Methods 

The CINAHL, MEDLINE, PubMed, Scopus, and PsycINFO databases were searched using PRISMA guidelines. Inclusion criteria were as follows: (1) quantitative research articles published between May 2008 and April 2019, (2) investigation of prehospital delay among women and men 15 years or older who were given a diagnosis of acute stroke or transient ischemic attack, and (3) English-language publications. The Crowe Critical Appraisal Tool was used to evaluate the quality of studies.

Results 

Fifteen publications (n = 162 856) met inclusion criteria. Most studies (n = 11) showed no sex differences in prehospital delay. Four studies from Asian-Pacific countries and the United States showed that women had significantly longer prehospital delay compared with men. Older age, minority race/ethnicity (black and Mexican American), and underuse of emergency medical services were associated with prolonged prehospital delay in women.

Conclusions 

Most study authors found no differences in prehospital delay between women and men; however, women delayed longer in some Asian-Pacific and American studies. Findings of sex differences were inconclusive.

中文翻译：

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急性中风患者院前延迟的性别差异：系统评价

背景 

2009年，从症状发作到给予组织性纤溶酶原激活剂治疗急性缺血性卒中的时间从3小时延长到4.5小时。自从这种改变以来，还没有系统的评论解决过因性别而导致的院前延迟。

目的 

我们的目的是（1）比较急性卒中或短暂性脑缺血发作的男女之间的院前延迟时间（从症状发作到到达医院的时间），以及（2）总结按性别影响院前延迟的因素。

方法 

使用PRISMA指南搜索CINAHL，MEDLINE，PubMed，Scopus和PsycINFO数据库。纳入标准如下：（1）在2008年5月至2019年4月之间发表的定量研究文章，（2）对被诊断为急性中风或短暂性脑缺血发作的15岁及以上的男女进行院前延迟调查，以及（ 3）英文出版物。Crowe关键评估工具用于评估研究质量。

结果 

共有15份出版物（n = 162 856）符合纳入标准。大多数研究（n = 11）显示院前延迟无性别差异。亚太国家和美国的四项研究表明，与男性相比，女性的院前延误时间明显更长。年龄较大，少数族裔/族裔（黑人和墨西哥裔美国人）以及对紧急医疗服务的利用不足，与妇女住院前延误时间长有关。

结论 

大多数研究作者发现，男女之间院前延误没有差异。但是，在某些亚太地区和美国的研究中，女性的延迟时间更长。性别差异的结论尚无定论。