Authors :
Presenting Author: Kristina Julich, MD – Dell Medical School
Hepsiba Barar, BS – Dell Medical School
Whitney Barry, MS – Dell Medical School
Christabelle Ogbonna, BS – Dell Medical School
Karla Robles Lopez, MD/PhD – Dell Medical School
Dave Clarke, MD – Dell Medical School
Rationale:
Disparities exist in all aspects of epilepsy care, including access to specialists and epilepsy surgery. At our institution, we developed an algorithm with the goal to standardize IS treatment in early 2020, at the beginning of the COVID19 pandemic. The rationale for this project was to identify potentially actionable disparities in care prior to implementation of the protocol.Methods:
We performed a chart review of all children admitted to our institution with a primary diagnosis of infantile spasms (ICD10 code G40.82) without TSC between the years of 2014 and 2019. We included race/ethnicity, insurance status, English proficiency as variables and examined choice of antiseizure medication (ASM), time to IS diagnosis and time to treatment from admission as outcomes.
Results:
221 patients were identified initially; charts with insufficient documentation were excluded. Ultimately, 99 patients were included for analysis of ASM, and 64 for time to diagnosis and time to treatment. Of this cohort, 48 (38%) were Hispanic, 36 (36%) were non-Hispanic whites, and 7 (7%) were non-Hispanic blacks. 39 (39%) had public and 49 (49%) private insurance, and 20 (20%) had limited English proficiency (LEP). Overall, children with limited English proficiency had slightly higher rates of standard first line therapy (75% vs 67%), time from spasm onset to diagnosis under seven days (50% vs 35%), and treatment initiation within 24hrs of admission (55% vs 39%) compared to English-speaking children. Children with public insurance were slightly less likely to receive standard first line therapy (67% vs 76%) and less likely to receive treatment within 24hrs of admission (32% vs 47%), with comparable rates of diagnosis of spasms within seven days of onset (41% vs 43%) compared to children with private insurance. When comparing non-Hispanic white children with historically minoritized groups (Hispanic and non-Hispanic black children), the likelihood of receiving standard therapy was comparable between groups (69% vs 73%). However, 44% of non-Hispanic white children received a diagnosis of infantile spasms within seven days of spasm onset, compared to only 25% of children from minoritized groups. Similarly, 52% of non-Hispanic white children started treatment within 24hrs of hospital admission, compared to only 28% of minoritized children. 48% of children from minoritized groups had spasms for one month or longer prior to diagnosis, compared to 28% of non-Hispanic white children.
Conclusions:
Our results suggest that in our catchment area, disparities exist in recognition and diagnosis of infantile spasms. Non-Hispanic white children access care sooner, and receive treatment quicker once admitted to the hospital compared to Hispanic and non-Hispanic black children. The choice of medication (standard vs non-standard treatment) was similar between groups. These findings highlight the importance of improved recognition of infantile spasms in minoritized groups.
Funding: KJ receives funding from the Clarke Family Foundation.