Disparities in Emergency Room Care for Children Presenting with Seizures
Abstract number :
3.463
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2232985
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:29 AM
Authors :
Megan Mitchell, BS – Dell Children's Medical Center; Dave Clarke, MD – The University of Texas at Austin Dell Medical School; Kristina Julich, MD – The University of Texas at Austin Dell Medical School
This is a Late Breaking abstract
Rationale: Social determinants of health have been shown to affect epilepsy diagnosis, management and outcome in adults, and disparities exist in remission rates for childhood epilepsy and time to epilepsy surgery. We sought to determine possible disparities in care delivery in the pediatric emergency room (ER) for children presenting with seizures, including children with limited English proficiency (LEP)/Spanish-speaking children.
Methods: We performed a retrospective chart analysis of 250 children who presented to the ER at Dell Children’s Medical Center in Austin, TX, between December 2018 and May 2019 with a primary diagnosis of seizure. Patients with febrile seizures, concomitant CNS infections, stroke/hemorrhage or trauma as a cause for the seizure were excluded. We analyzed race, ethnicity, English proficiency/primary language, insurance, and compared rates of admission and workup with brain imaging and EEG. Significance was determined using chi square test.
Results: Of 250 patients, 132 (53%) were Hispanic and 118 non-Hispanic (47%). 88 were non-Hispanic Whites (35%), and 30 (12%) African American. 41 (16%) had limited English proficiency (LEP). 25% of non-Hispanic Whites had Medicaid compared to 69% of Hispanic and 83% of African American children. The hospital admission rate from the ER after a seizure for non-Hispanic White children was 43%, compared to 33% for African American (p 0.34) and 20% for LEP children (p 0.009). 27% of non-Hispanic Whites underwent brain imaging (in ER and/or during admission), and 18% had an EEG, while 25% of LEP and 23% of African American children had brain imaging (in ER only), and only 2% of LEP and 3% of African American children had an EEG (p 0.012 and 0.045, respectively). 21% of children with Medicaid were admitted, 24% had brain imaging, and 10% an EEG, while 52% of children with commercial insurance were admitted, 33% underwent brain imaging, and 19% had an EEG (p values < 0.00001 for admission rates, 0.88 for imaging, 0.05 for EEG).
Health Services (Delivery of Care, Access to Care, Health Care Models)