Evidence map›Paper›PMID 41632058›Full record

ArticleAnnals of emergency medicine2026

Social Vulnerability and Out-of-Hospital Identification of Neurologic Emergencies.

Andrew J Wood, Nicole Rosendale, Remle Crowe, J Daniel Kelly, Elan L Guterman

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Andrew J WoodDepartment of Neurology, University of California, San Francisco, CA. Electronic address: andrew.wood@ucsf.edu.
Nicole RosendaleDepartment of Neurology, University of California, San Francisco, CA; Weill Institute for Neurosciences, University of California, San Francisco, CA; Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
Remle CroweESO Solutions, Inc., Austin, TX; Department of Emergency Health Sciences, University of Texas Health San Antonio, San Antonio, TX.
J Daniel KellyDepartment of Medicine, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; San Francisco VA Medical Center, San Francisco, CA; Institute for Global Health Sciences, University of California, San Francisco, CA; Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
Elan L GutermanDepartment of Neurology, University of California, San Francisco, CA; Weill Institute for Neurosciences, University of California, San Francisco, CA; Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.

Funding

The Care Ecosystem: Navigating patients and caregivers through stages of dementia careR01AG056715 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI POSSIN, KATHERINE LAUREL · 2017 to 2021
$6.0M
Prehospital Management of Status EpilepticusK23NS116128 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GUTERMAN, ELAN · 2020 to 2024
$1.1M
Understanding the epidemiology and natural history of unrecognized Ebola virus infectionK23AI146268 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KELLY, JOHN DANIEL · 2019 to 2022
$748k
NIAID NIH HHS K23 AI146268NIA NIH HHS R01 AG056715NINDS NIH HHS K23 NS116128
6 · The paper itself

Abstract

STUDY

objectiveTimely out-of-hospital recognition and management of neurologic emergencies-including status epilepticus, stroke, intracerebral hemorrhage, and traumatic brain injury-are critical to improving patient outcomes. However, the influence of social risk factors on the delivery and quality of emergency medical services (EMS) care in these time-sensitive conditions remains poorly understood and may contribute to long-term morbidity and mortality. This study examines the association between community-level social vulnerability and out-of-hospital identification of neurologic emergencies.

methodsThis retrospective cohort study used data from the ESO Data Collaborative research dataset from January 2019 through December 2022. The dataset covers EMS agencies across the United States that participated in the ESO Data Collaborative research dataset, which includes a health data exchange linking EMS and emergency department encounters. EMS encounters initiated via 911 calls for patients of all ages diagnosed in the emergency department with status epilepticus, stroke, intracerebral hemorrhage, or traumatic brain injury, as determined by primary International Classification of Diseases-10 codes, were included for analysis. Social vulnerability was measured at the census tract level using the Social Vulnerability Index, categorized in quintiles. Our primary outcome was EMS identification of the neurologic emergency, defined as an out-of-hospital impression or treatment protocol consistent with the emergency department diagnosis.

resultsAmong 69,842 EMS encounters, 35,729 (51.2%) were for stroke, 23,607 (33.8%) for traumatic brain injury, 5,911 (8.5%) for intracerebral hemorrhage, and 4,595 (6.6%) for status epilepticus. Patients in the most socially vulnerable census tract quintile had a 33% greater risk of EMS not identifying the neurologic emergency (risk ratio [RR] 1.33; 95% confidence interval [CI] 1.23 to 1.43) compared to the least vulnerable quintile. Condition-specific analyses showed social vulnerability was associated with an increased risk of not identifying stroke (RR 1.31; 95% CI 1.22 to 1.41) and traumatic brain injury (RR 1.17; 95% CI 1.03 to 1.32). No significant association was found for status epilepticus (RR 0.90; 95% CI 0.73 to 1.10) or intracerebral hemorrhage (RR 1.09; 95% CI 0.99 to 1.20).

conclusionHigher neighborhood social vulnerability was associated with lower rates of out-of-hospital neurologic emergency identification, particularly stroke and traumatic brain injury. Targeted strategies are needed for equitable out-of-hospital recognition and response for time-sensitive neurologic conditions.

Indexed as

Brain Injuries, TraumaticCerebral HemorrhageEmergency Medical ServicesSocial VulnerabilityStatus EpilepticusStrokeAdolescentAdultAgedChildChild, PreschoolEmergenciesFemaleHumansMaleMiddle AgedEmergency medical servicesHealth disparitiesNeurologic emergenciesOut-of-hospital identificationSocial Vulnerability Index

Identifiers

PMID41632058
PMCPMC13500433

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.