Authors :
Presenting Author: Christopher Saouda, MD – The George Washington University
Radwa Aly, PhD, MSc, CPI – Office of Clinical Research – The George Washington University; Henry Kaminski, MD – Neurology and Rehabilitation Medicine – The George Washington University; Timothy McCall, PhD – Director, Health Sciences (HSCI) Undergraduate Courses, The George Washington University; Mohamad Koubeissi, MD, MA, FAAN, FANA, FAES – Professor, Interim Chair, Neurology and Rehabilitation Medicine, The George Washington University
Rationale:
The Centers for Disease Control define health disparities as “differences in health outcomes and their causes among different groups of people.” The social determinants of health refer to how disparities relate to social, economic, and environmental disadvantages, to which minority groups are particularly vulnerable. Washington DC is geographically divided into 8 Wards with Wards 7 and 8 having highest concentration of minority populations, specifically African Americans (AA). Minorities constitute 97.03% and 95.84% of the population in Wards 7 and 8 respectively. These two Wards also have the lowest gross median household incomes in Washington D.C. In this study, we aimed to assess whether race and the Ward of origin determine the frequency of emergency department (ED) visits and revisits in patients with epilepsy and psychogenic non-epileptic seizures (PNES).
Methods:
We conducted an IRB-approved electronic retrospective chart review of adult patients with paroxysmal episodes presenting to the ED at George Washington University Hospital over two years (2018 through 2019). We extracted information including patient characteristics, anti-seizure medications (ASM), length of ED stay, neurology consult status, and revisits. We included epilepsy and PNES, but excluded syncope and other physiologic non-epileptic episodes.
Results:
In the two studied years, 310 patients (138 women, 283 with epileptic seizures and 27 with PNES) presented to the ED. Among those with epilepsy, 33 patients (12%) had a confirmed diagnosis in a prior epilepsy monitoring unit (EMU) admission, and among the PNES group, 4 (15%) had a confirmed diagnosis in the EMU. Of all subjects, 212 (68%) were AA, 60 (19%) were White, and 38 (13%) were from other races. With regard to patient residence, 41.61% came from Wards 7 and 8 of Washington, DC. There was no difference in the likelihood of prescribing ASMs, obtaining Neurology consult, or the length of stay in the ED based on race or Ward of origin. However, 44 patients (14%) had revisits within the studied duration, with a mean of 3 (
±1) visits. Among those, 34 patients (77%) were AA, half of whom were from Wards 7 and 8. Conclusions:
Our data suggest that low-income areas and AAs disproportionately present to (and revisit) the ED to manage their epileptic and non-epileptic seizures. This may reflect the paucity or lack of adequate healthcare resources in low-income Wards and is in line with prior data that found higher risks of heart attack among residents of Wards 7 and 8. In addition, the results highlight the urgent need for efforts to reduce disparities, including, but not limited to, the implementation of telemedicine.
Funding: No funding was received in support of this abstract.