Title: Lack of racial and ethnic-based differences in acute care delivery in intracerebral hemorrhage
Country: United States
Age: Adult Only
Sex: All Sexes
Population: Multiple Groups
Care Setting: Emergency Department
Clinical Setting: Neurologic
Data Level: Single Institution
Data Type: EHR
Data Source: Local data
Conclusion: No Disparities Based on Patient Race/Ethnicity
Health OutComes Reported: Yes
Free Text Conclusion: Non-White race/ethnicity had no effect on acute care processes (including time to CT scan) and was not associated with worse outcomes. Native English speakers were associated with slower times to CT, but not associated with worse outcomes.
Abstract: BACKGROUND AND AIM: Early 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. METHODS: We 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. RESULTS: Four 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 ( = 30.7 min, 95% CI 9.9 to 51.4, p = 0.004) and to bed request ( = 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. CONCLUSIONS: We 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.