Sex-Related Differences in Symptoms Among Patients Presenting with Acute Stroke: A Systematic Review and Meta-analysis

Abstract

Background: Recognising acute stroke symptoms is crucial in providing timely treatment. However, evidence suggests that females often experience unique symptoms compared with males, resulting in delays to seeking medical attention and treatment. This systematic review and meta-analysis evaluated whether sex is associated with differences in acute stroke symptoms. Methods: Searches from 1946 to 7th September 2021 were carried out using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. Studies reporting acute stroke symptoms in adult females and males were eligible for inclusion. Eleven observational studies met the inclusion criteria. Methodological quality was assessed using the Newcastle–Ottawa scale (NOS). Data were meta-analysed using a random-effects model. Results: Compared with males, females had higher odds of experiencing headache (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.01–1.59); change in level of consciousness (OR: 1.36; 95% CI: 1.13–1.63); fatigue (OR: 1.53; 95% CI: 1.04–2.25); and incontinence (OR: 1.44; 95% CI: 1.29–1.60). In contrast, females were at lower odds of experiencing trouble speaking (OR: 0.79; 95% CI: 0.64–0.96); trouble walking, loss of balance, or co-ordination (OR: 0.55; 95% CI: 0.39–0.76); and dizziness (OR: 0.77; 95% CI: 0.64–0.94) compared with males. No difference was found in confusion, difficulty understanding speech, trouble seeing in one or both eyes, mental status change, and nausea or vomiting. Discussion: Sex differences do exist in some acute stroke symptoms. At the same time, the overlap in symptoms between sexes was substantial. Healthcare professionals and public health campaigns should continue to promote classic symptoms of acute stroke, whilst taking into account the less common symptoms and the potential differences in symptoms experienced by females and males.