Abstract WP76: Utilization Rate and Predictors Utilization of Transcranial Doppler Ultrasound Amongst Stroke Population of USA - A Nationwide Study

Abstract

Introduction: Transcranial Doppler Ultrasound (TCD) has proven to be useful in monitoring vasospasm after intracerbral hemorrhage (ICH), predicting delayed ischemic stroke (AIS) (sensitivity 91.2%, specificity 80.8%), and assessing recanalization post-thrombolysis for AIS. (91%, 93%). Findings were limited by small sample size and non-nationwide representation for the USA. We aimed to evaluate the utilization and predictors of utilization of TCD in ICH and AIS hospitalizations of the USA. Methods: A retrospective cross-sectional study on the Nationwide Inpatient Sample was analyzed using the year 2003-2014. Hospitalizations with ICH, AIS, and TCD were identified using the ICD-9-CM codes 431 and 433-437.XX as a primary diagnosis and 88.71 respectively. Univariate and multivariate logistic regression analysis were performed to find out utilization rate and predictors of utilization in ICH and AIS. Results: We found 715,516 ICH and 4,224,924 AIS hospitalizations of those 4,405(0.62%) in ICH and 93,673(2.22%) in AIS had TCD utilization. Utilization trend has declined in ICH(0.99% in 2003 to 0.71% in 2014, pTrend<0.0001) and AIS (3.84% in 2003 to 1.34% in 2014, pTrend<0.0001). In regression analysis of AIS hospitalizations, age group 65 and above(1.7, 1.3-2.2), African American(1.5, 1.5-1.6), Hispanic(1.63, 1.6-1.7), income 76-100th percentile(1.2, 1.2-1.3), hypertensives(1.05, 1.01-1.1), hypercholesterolemia (1.2, 1.2-1.3), alcohol abuse(1.1, 1.00-1.2) and anticoagulant users(1.5; 1.4-1.6), had higher odds of TCD utilization. Amongst ICH, TCD utilization was higher in African-American/Hispanic; medium to large size/urban-teaching hospital, drug abusers(6.5, 1.6-25.5), hypercholesterolemia(1.8, 1.4-2.3), and those with external ventricular drain(2.1, 1.1-4.2). Conclusion: Despite the proven higher sensitivity and accuracy of TCD in ICH and AIS, its utilization has declined. This is concerning, especially given the potential benefits for specific patient populations like African Americans and hypertensives who may have higher needs for stroke monitoring. To address this disparity, it is imperative that more comprehensive studies be conducted to thoroughly examine the outcomes and cost-utility of TCD.