Disparities in the Utilization of Anti-seizure Medications in Critically Ill Patients Undergoing Continuous Electroencephalogram Monitoring
Abstract number :
3.402
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2205144
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Fazila Aseem, MD, MPH – University of North Carolina; Camille Liu, MS – Biostatistics – University of North Carolina; Deepthi Nalluri, MD – Neurology – University of North Carolina; Monica Dhakar, MD, MS – Neurology – Warren Alpert School of Medicine; Fei Zou, PhD – Biostatistics – University of North Carolina; Adithya Sivarajy, MD – Neurology – Yale University; Sahar Zafar, Md, MSc – Neurology – Massachusetts General Hospital; Vineet Punia, MD – Neurology – Charles Shor Epilepsy Center, Cleveland Clinic; Clio Rubinos Rubinos, MD, MS – Neurology – University of North Carolina
Rationale: Acute symptomatic seizures (ASyS) and epileptiform abnormalities (EAs) are commonly seen in acutely ill patients. A growing body of literature highlights racial disparities in the diagnosis and management of seizures. One study shows that whites are almost twice as likely as blacks to be administered prophylactic levetiracetam after intracerebral hemorrhage, however, the association was confounded by hematoma location. Otherwise, there is limited data regarding disparities in the use of anti-seizure medications (ASMs) in patients undergoing continuous electroencephalogram monitoring. (cEEG). Therefore, the objective of this study was to assess potential disparities in the use of ASMs and outcomes in patients undergoing cEEG
Methods: We obtained multicenter retrospective cohort data for adult patients who underwent cEEG from July to September 2021, in three tertiary hospitals across the United States, members Post-Acute Symptomatic Seizure Investigation and Outcome Network (PASSION). Patients with prior history of epilepsy and younger than 18 years of age were excluded. Only ASMs used for >48 hours were included. Chart reviews were conducted to record patient demographics, acute central nervous system disease, clinical and electrographic ASyS, utilization of ASMs, cEEG parameters and discharge outcomes (by Glasgow Outcome Scale, GOS) for 690 patients. Statistical models were then used to assess racial and ethnic disparities in the utilization of ASMs and outcomes.
Results: The use of ASMs for prophylaxis and treatment of clinical and electrographic ASyS did not vary significantly by race (p=0.09 and p=0.32, respectively) and ethnicity (p=0.19 and p=1, respectively). There was no difference in the use of ASMs for epileptiform discharges (EAs) seen on cEEG after correcting for neurological insults, including acute brain injury, brain neoplasm, cerebral inflammatory diseases, toxic metabolic encephalopathy, and cardiac arrest, when stratified by race (p=0.07) and ethnicity (p=0.13). The prescription of ASMs upon discharge did not vary significantly by race (p=0.2) and ethnicity (p=0.38). On multivariable analysis, ASMs use was associated with worse outcomes (GOS= 1-3) in white patients when compared to white patients that were not on ASMs [odds ratio (OR)=0.624 (95% CI= 0.4 – 0.9)], after adjusting for age, sex, center, type of brain injury, length of stay, status epilepticus and use of intravenous sedation. No association in outcomes was seen in Black patients.
Conclusions: Our multicenter data show that the use of ASMs was associated with worse outcomes in white patients when compared to white patients that didn’t receive ASMs. While our data from three-center study did not show any apparent disparities in the prophylactic and therapeutic use of ASMs in clinical and electrographic ASyS and in the use of ASMs for EAs seen on cEEG, our study is limited by the sample size. Further research is needed to better understand disparities in ASMs management in this population in order to develop appropriate quality improvement interventions.
Funding: American Epilepsy Society Infrastructure Grant 2021
Health Services (Delivery of Care, Access to Care, Health Care Models)