Abstract Details

Title Socioeconomic Bias in Ordering Toxicology Screens in Patients with an Acute Stroke

Topic Health Care Disparities

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 11-004

Background Current guidelines for the management of acute IS in 2021 and ICH in 2015 recommend TOX screens to detect cocaine and other sympathomimetic drugs of abuse without discrimination by socioeconomic status. Retrospective studies have demonstrated bias on drug screening of young African-American ICH patients despite current guidelines.

Objective

We sought to explore current toxicology(TOX) screen use for both ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients to discover if there was any bias in our clinical practices.

Design/Methods

A single center retrospective review of electronic medical records between January 1^st, 2018-Dec 31^st, 2019, with the following diagnosis: IS, transient ischemic attack (TIA), ICH, and subarachnoid hemorrhage. We recorded demographic data: age, gender, race/ethnicity, insurance status, cardiovascular co-morbidities, drug and alcohol screen. We present data with descriptive statistics and covariant analyses.

Results

We reviewed 725 patient charts. There were 406 (56%) white, 161 (23%) African American, 90 (12%) Hispanic and 66 (9%) other race/ethnicities. There was 137/725 (19%) TOX screens ordered. Distributed by race; 61/408(15%) white, 56/161 (35%), African-Americans 20/90 (23%) Hispanic and 8/166 (12%) others had TOX screens. By insurance status, patients with TOX screens had predominantly Medicaid (44%) or no-insurance (30%). TOX screens was ordered on 31% of those <55 yo and TOX screen was ordered on 17% >55 yo. There was 483/725 (66%) IS or TIA and 242/725 (33%) ICH. TOX screen was ordered on 82/483 (17%) IS and 65/242 (27%) ICH. Controlling for age, TOX screens ordered were 3 times more in younger adults (p<.01), 2.6 times more in uninsured and Medicaid (P.01) and race was not statistically significant.

Conclusions

At our center, there appears to be unintended socioeconomic bias in ordering TOX screens both for ICH and IS. Awareness of implicit bias and better standardization in care for evaluation of drug use in ischemic and hemorrhagic stroke patients is essential.

Authors/Disclosures
Fady Mousa-Ibrahim, DO (Nothwestern University Mcgaw Medical Center) PRESENTER	Dr. Mousa-Ibrahim has nothing to disclose.
Konrad Kubicki, MD (Rush University Medical Center)	Dr. Kubicki has nothing to disclose.
Alexandria Cummuta	Ms. Cummuta has nothing to disclose.
Christopher Richardson (UPMC)	Mr. Richardson has nothing to disclose.
Michael J. Schneck, MD, FAAN (Loyola University Chicago, Stritch School of Medicine)	An immediate family member of Dr. Schneck has received personal compensation for serving as an employee of Cellcarta. Dr. Schneck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for HLT Medical. Dr. Schneck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miscellaneous legal firms. Dr. Schneck has stock in Baxter Labs. The institution of Dr. Schneck has received research support from NIH.
	No disclosure on file