Abstract TP239: Race and the Utilization of Diagnostic Procedures in the Emergency Department for Acute Stroke in the United States

Abstract

Introduction: In 2007, the AHA recommended the use of the following diagnostic procedures immediately upon admission to the emergency department (ED) for all adult patients with suspected stroke: noncontrast brain CT or brain MRI, electrocardiogram, complete blood count (CBC) including platelets, cardiac enzymes and troponin, electrolytes, urea nitrogen, creatinine, serum glucose, prothrombin time and international normalized ratio (PT/INR), and oxygen saturation. We described the overall rate of utilization of these procedures and assessed for association with race using a national ED survey. Methods: We identified 308 ED visits for ischemic and spontaneous hemorrhagic strokes in adults 18 years representing 1.2 million stroke-related ED visits in the US using the National Hospital Ambulatory Medical Care Survey for years 2008-2009. The association between rates of utilization of diagnostic procedures and race was assessed using a Pearson chi-square test. Results: Overall the most common and least common diagnostic procedures performed were measurement of oxygen saturation (93%) and PT/INR (40%), respectively. There was no difference in use of CT/MRI (82.3% vs 82.7%, p =0.952), electrocardiogram (79.3% vs 80.7%, p =0.875), CBC (82.4% vs 93.9%, p =0.093), cardiac enzymes and troponin (55.7% vs 60.9%, p =0.523), electrolytes (57.4% vs 70.0%, p =0.153), urea nitrogen and creatinine (70.0% vs 68.5%, p =0.858), serum glucose (63.8% vs 66.8%, p =0.721), PTT/INR (37.3% vs 50.8%, p =0.139), and oxygen saturation (91.9% vs 98.7%, p =0.063) in blacks and whites, respectively. Conclusion: In terms of race, we found no significant difference in the rate of ED utilization of diagnostic procedures for acute stroke in the US. The overall rates of adherence to the 2007 AHA guidelines for diagnosis of acute stroke differed by diagnostic procedure. While there was almost universal measurement of oxygen saturation, less than half of acute stroke patients had a PT/INR analysis.