Abstract
Background and aimEarly diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. We examined whether racial or ethnic disparities exist in acute care processes in the first hours after ICH.MethodsWe performed a retrospective review of a prospectively collected cohort of consecutive patients with spontaneous primary ICH presenting to a single urban tertiary care center. Acute care processes studied included time to computerized tomography (CT) scan, time from CT to inpatient bed request, and time from bed request to hospital admission. Clinical outcomes included mortality, Glasgow Outcome Scale, and modified Rankin Scale.ResultsFour hundred fifty-nine patients presented with ICH between 2006 and 2018 and met inclusion criteria (55% male; 75% non-Hispanic White [NHW]; mean age of 73). In minutes, median time to CT was 43 (interquartile range [IQR] 28, 83), time to bed request was 62 (IQR 33, 114), and time to admission was 142 (IQR 95, 232). In a multivariable analysis controlling for demographic factors, clinical factors, and disease severity, race/ethnicity had no effect on acute care processes. English language, however, was independently associated with slower times to CT (β = 30.7 min, 95% CI 9.9 to 51.4, p = 0.004) and to bed request (β = 32.8 min, 95% CI 5.5 to 60.0, p = 0.02). Race/ethnicity and English language were not independently associated with worse outcome.ConclusionsWe found no evidence of racial/ethnic disparities in acute care processes or outcomes in ICH. English as first language, however, was associated with slower care processes.
Highlights
Background and aimEarly diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes
Minority patients have been found to receive slower or worse acute care in mild traumatic brain injury [6], acute asthma [7], and stroke [8, 9]. It is not clear whether those presenting with ICH, a stroke subtype with an often acute and clear change in neurologic function, are subject to the same potential biases in clinical management that may be found in other disease processes
Because of the importance of early and efficient treatment [1] and a paucity of prior research examining the acute care processes in ICH among different racial and ethnic groups, it is important to determine whether disparities exist in this area, and if so whether they are associated with worse outcomes
Summary
Background and aimEarly diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. Minority patients have been found to receive slower or worse acute care in mild traumatic brain injury [6], acute asthma [7], and stroke [8, 9] It is not clear whether those presenting with ICH, a stroke subtype with an often acute and clear change in neurologic function, are subject to the same potential biases in clinical management that may be found in other disease processes. Because of the importance of early and efficient treatment [1] and a paucity of prior research examining the acute care processes in ICH among different racial and ethnic groups, it is important to determine whether disparities exist in this area, and if so whether they are associated with worse outcomes
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