Disparities in the Use of Seizure Medications after Intracerebral Hemorrhage

Andrew M. Naidech*, Paloma Toledo, Shyam Prabhakaran, Jane L. Holl

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background and Purpose - We investigated potential disparities in the use of prophylactic seizure medications in patients with intracerebral hemorrhage. Methods - Review of multicenter electronic health record (EHR) data with simultaneous prospective data recording. EHR data were retrieved from HealthLNK, a multicenter EHR repository in Chicago, Illinois, from 2006 to 2012 (multicenter cohort). Additional data were prospectively coded (single-center cohort) from 2007 through 2015. Results - The multicenter cohort comprised 3422 patients from 4 HealthLNK centers. Use of levetiracetam varied by race/ethnicity (P=0.0000008), with whites nearly twice as likely as blacks to be administered levetiracetam (odds ratio: 1.71; 95% confidence interval, 1.43-2.05; P<0.0001). In the single-center cohort (n=450), hematoma location, older age, depressed consciousness, larger hematoma volume, no alcohol abuse, and race/ethnicity were associated with levetiracetam administration (P≤0.04). Whites were nearly twice as likely as blacks to receive levetiracetam (odds ratio: 1.9; 95% confidence interval, 1.25-2.89; P=0.002); however, the association was confounded by history of hypertension, higher blood pressure on admission, and deep hematoma location. Only hematoma location was independently associated with levetiracetam administration (P<0.00001), rendering other variables, including race/ethnicity, nonsignificant. Conclusions - Although multicenter EHR data showed apparent racial/ethnic disparities in the use of prophylactic seizure medications, a more complete single-center cohort found the apparent disparity to be confounded by the clinical factors of hypertension and hematoma location. Disparities in care after intracerebral hemorrhage are common; however, administrative data may lead to the discovery of disparities that are confounded by detailed clinical data not readily available in EHRs.

Original languageEnglish (US)
Pages (from-to)802-804
Number of pages3
JournalStroke
Volume48
Issue number3
DOIs
StatePublished - Mar 1 2017

Funding

This project was supported by grant number K18HS023437 from the Agency for Healthcare Research and Quality to Dr Naidech. Dr Prabhakaran received research support from National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH/NINDS): NS084288-01A1 (3/2014-present; PI) and 1U10NS086608- 01 (10/2013-present, PI) and the Patient Centered Outcomes Research Institute: AD-1310-07237 (10/2014-present, PI). Dr Holl reports research support from Agency for Healthcare Research and Quality HS000078-18 and past support from Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Project Number 275201200007I-2-27500010-1.

Keywords

  • brain
  • cerebral hemorrhage
  • critical care
  • privacy
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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