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 language | English (US) |
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Pages (from-to) | 802-804 |
Number of pages | 3 |
Journal | Stroke |
Volume | 48 |
Issue number | 3 |
DOIs | |
State | Published - 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