Racial Disparities in Urine Drug Screening in Patients with Seizures in the Emergency Department
Abstract number :
3.194
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2021
Submission ID :
1825673
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Gloria Ortiz Guerrero, MD - University of Kansas Medical Center; Maggie Logan, MD - University of Kansas Medical Center; Patrick Landazuri, MD – Epileptologist, Neurology, University of Kansas Medical Center; Utku Uysal, MD – Epileptologist, Neurology, University of Kansas Medical Center; carol Ulloa, MD – Epileptologist, Neurology, University of Kansas Medical Center
Rationale: Seizures account for 1-2% of all emergency department (ED) visits in the USA. Although seizures are one of the most common reasons to visit the ED, disparities in seizure care related to race have been documented. According to different surveys, the use of recreational drugs has raised over the last few years. When looking at the drug use by races, whites and blacks had similar rates (20.2% vs. 20.8%), according to the National Survey on Drug Use and Health in 2018. Unfortunately, there are no studies available in the literature looking at racial disparities in drug screening in the seizure population. Here, we hypothesized that black patients with suspected seizures in the ED are tested for urine drug screen (UDS) more often than whites. This study aimed to determine the UDS rate by race and ethnicity in patients with suspected seizures seen in the ED. We further evaluated the positivity rate of UDS by race and identified the most common drugs used by each race.
Methods: In this retrospective study, patients over 18 with suspected seizures who presented to the ED between 10/1/2017 to 10/31/2020 and had a UDS performed were identified through a Healthcare Enterprise Repository for Ontological Narration (HERON) database. Demographic, clinical, and UDS data were collected and were compared between black and white patients as well as Hispanic and non-Hispanic patients. The Chi-square test was applied to assess the differences in UDS testing based on the patient’s race.
Results: Two thousand nine hundred forty-five patients were identified, of which 612 (20.8%) were drug screened. More white (59.4%) than black (27.9%) patients were seen for suspected seizures. A higher percentage of black patients were urine drug-screened compared to whites (23% vs. 20% – p=0.046), and the positivity rate was also higher in black patients (59% vs. 48% - p=0.019). Regarding ethnicity, Hispanics were more likely to be tested, but this was not statistically significant (p=0.164). However, non-Hispanics had a higher rate of positive UDS (p=0.007). Benzodiazepines were the most common drug detected in white patients (36%), whereas marijuana was the most common in black patients (38%). 69% of white vs. 64% of black patients were admitted into the hospital. One black patient (0.5%) was discharged against medical advice. EEG was performed equally in 34% of both white and black patients, and the most common abnormal finding was generalized slowing in both races.
Conclusions: We concluded that black patients with suspected seizures in the ED are urine screened for drugs more often than whites. UDS positivity rate was higher in black patients. Similar results but focused on the stroke population found that black patients were also more likely to be drug screened with a higher positivity rate of cocaine. No relationship is noted for testing by ethnicity. Benzodiazepines and marijuana were the most common drugs used in white and black patients, respectively. These results may suggest a racial disparity in seizure care related to drug screening in the ED.
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy