Faculty Collaboration Database

Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage. Neurology 2017 Jan 17;88(3):252-258

Date

12/09/2016

Pubmed ID

27927933

Pubmed Central ID

PMC5272789

DOI

10.1212/WNL.0000000000003505

Scopus ID

2-s2.0-85009912636 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

OBJECTIVE: To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers.

METHODS: We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns.

RESULTS: We identified 610 patients with primary ICH in 2009-2011; 379 (62.1%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients <55 years of age, only 65/140 (46.4%) were screened. Black patients <55 years of age were screened more than nonblack patients <55 years of age (38/61 [62.3%] vs 27/79 [34.2%]; p = 0.0009). In the best multivariable model, age group (p = 0.0001), black race (p = 0.4529), first Glasgow Coma Scale score (p = 0.0492), current smoking (p < 0.0001), and age group × black race (p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion <55 years of age who were screened: 42/74 (56.8%) were screened before and 23/66 (34.9%) after (p = 0.01).

CONCLUSIONS: We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling.

Author List

Tormoehlen LM, Blatsioris AD, Moser EA, Carter RJ, Stevenson A, Ofner S, Hulin AL, O'Neill DP, Cohen-Gadol AA, Leipzig TJ, Williams LS, Mackey J

Author

Darren P. O'Neill MD Vice Chair, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Distribution
Aged
Cerebral Hemorrhage
Cohort Studies
Female
Glasgow Coma Scale
Guideline Adherence
Health Status Disparities
Humans
Logistic Models
Male
Middle Aged
Substance Abuse Detection
Substance-Related Disorders