Abstract
Background: Current guidelines for the management of acute ischemic stroke (IS) in 2021, and intracerebral hemorrhage (ICH) in 2015 recommend toxicology (TOX) screens to detect cocaine and other sympathomimetic drugs of abuse without discrimination by race/ethnicity or socioeconomic status. Retrospective studies have demonstrated bias, however, on drug screening of young African-American ICH patients despite current guidelines. We sought to explore our current screens use for both IS and ICH patients to discover if there was any bias in our clinical practices. Methods: A single center retrospective review of electronic medical records between January 1 st 2018-Dec 31 st 2019. With the following diagnosis; IS, transient ischemic attack (TIA), ICH, and subarachnoid hemorrhage We recorded demographic data; age, gender, race/ethnicity, insurance status, cardiovascular comorbidities, drug and alcohol screen. We present data with descriptive statistics with plans for covariant analyses Results: We reviewed 725 patient charts. There were 406 (56%) white, 161 (23%) African American, 90 (12%)Hispanic and 66 (9%)other race/ethnicities. There was 146/725 (20%) tox screens ordered. Distributed by race; 61/408(15%) white, 56/161 (35%), African-Americans 20/90 (23%) Hispanic and 8/166 (12%) others had tox screens. Tox was ordered in 75/373 (20%) males and 71/352 (20%) females. By insurance status, patients with tox screens had predominantly Medicaid (44%) or no-insurance (30%). Tox screens was ordered on 31% of those <55 yo and tox screen was ordered on 17% >55 yo. There was 483/725 (66%) IS or TIA and 242/725 (33%) ICH. Tox screen was ordered on 82/483 (17%) IS and 65/242 (27%) ICH Conclusion: At our center, there appears to be unintended ethnic and/or economic bias in ordering toxicology screens both for ICH and IS. Awareness of implicit bias and better standardization in care processes for evaluation of drug and alcohol use in ischemic and hemorrhagic stroke patients is essential.
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