264 - Disparities in Neurology Follow-Up and Neuroimaging in Children with Headache or Seizure Discharged from the Pediatric Emergency Department

Poster Number: 264
Publication Number: 264.1484

Background: Emergency and post-emergency care outcomes are a focus of disparities in healthcare. It is known that patients with different insurance, socioeconomic, and demographic statuses experience variations in follow-up appointments, diagnostic testing, or specialty consultations. It is unknown how it manifests with neurology complaints in the emergency department (ED).

Objective: To determine the association between sociodemographic factors and ED/post- emergency care outcomes for children evaluated in a pediatric ED for headache or seizure (excluding febrile/post-traumatic).

Design/Methods: We performed a single center retrospective chart review of children < 18 years of age evaluated in the ED between 01/01/2016 and 12/31/2020, and collected patient demographics, ED, and post-ED outcomes. Race/ethnicity was categorized as minoritized vs non-minoritized populations using the Office of Management and Budget (OMB) definition. Multivariate logistic regression models were utilized to assess associations between patient characteristics and odds of neurology follow-up and neuroimaging.

Results: 8,965 children were included in the final analysis. Patients’ demographics and clinical characteristics are presented in Table 1. 4.4% of children with headache and 15% with seizure had  1 subsequent ED visit. Among those with a neurologist follow up (7.9% in headache group and 55.9% in seizure group), the mean + SD time to neurology follow up for headache diagnoses was 76 + 52 days and 62 + 49 days for seizure diagnoses. Proportion of children receiving neurology follow-up and neuroimaging are presented in Figure 1 and 2, respectively. Minoritized children’s odds of receiving a neurologist follow-up for headache and seizure diagnoses decrease by 39% (OR = 0.61, p < 0.001) and 33% (OR = 0.67, p < 0.001), respectively, compared to non-minoritized children. Similar pattern was observed for children with headache from non-English speaking families compared to those from English speaking families (OR = 0.73, p = 0.003). Among headache diagnoses, the odds of receiving MRI (vs. CT) are lower for publicly insured children compared to privately insured children (OR = 0.49, p = 0.002), and for minoritized children compared to non-minoritized children (OR = 0.53, p = 0.01).

Conclusion(s): Disparities in the proportion of children who received a neurology follow-up after their ED visit for seizure or headache exist. Our findings highlight the need for research to understand the root cause of neurology care connection disparities.