Abstracts

Rationale: Blacks and Hispanics have a twofold higher prevalence of epilepsy when compared to Whites, but tend to receive less state of the art therapies. A prior study analyzed Emergency Department (ED) visits for seizure using a large national database. Their analysis found that Blacks were less likely to be admitted to the hospital, and that Blacks, Hispanics, and patients without private insurance were less likely to receive neuroimaging. We reviewed all ED visits for seizure during one year to see if disparities in treatment were similarly noted and, if present, to investigate potential reasons for them. Methods: This study was approved by the Partners Human Research Committee. We retrospectively reviewed the electronic medical records of patients seen in a large urban tertiary medical center ED from 1/1/2008- 12/31/2008 with ICD-9 codes for epilepsy, seizures, myoclonus, and convulsions (345, 333.2, and 780.3). Only visits with seizure as the precipitating factor were included. Data were collected on race, insurance [private vs. non-private (Medicare, Medicaid/MassHealth, Commonwealth Care, self pay, and no insurance/ health safety net)], frequency of ED visits in the year, probable cause of seizure, and ED management (lab results, medication management, neuroimaging, and admission). Statistical comparisons used generalized linear mixed models accommodating multiple visits per patient (SAS 9.2). Results: Of 38,879 total ED visits, there were 559 visits for seizure (1.5%) made by 442 patients. Of these 442 patients, 267 (61%) were white, and 170 (39%) were non-white (Black n=100; Hispanic n=59; Asian n=11). The mean age was 48 years, and 51% were male. Non-white patients were less likely to receive neuroimaging in the ED (p = 0.02), and were less likely to be admitted to the hospital (p < .0001). Patients who did not have private insurance showed a trend towards less neuroimaging (p = 0.06), but were just as likely to be admitted as those with private insurance (p = 0.46). Non-whites were more likely to have multiple ED visits for seizure within the year (p=0.001), and to have a history of epilepsy (p=0.01). Whites and non-whites were equally likely to have electrolytes, a toxicology screen, and/or an anti-epileptic drug (AED) loaded. While both groups were equally likely to present for seizure without a clear cause, non-whites were more likely to have not adhered to their medication regimen (missed or ran out of AEDs) as the cause of their seizure visit (p=0.001).