Abstract TMP29: Emergency Department Variability In Use Of Advanced Neuroimaging By Insurance Status

Abstract

Introduction: Prior data indicate inpatient disparities exist among patients with stroke associated with insurance status for degree of neurologic impairment, hospital length of stay and mortality. Patients presenting to the Emergency Department (ED) with acute neurologic symptoms often require evaluation for acute ischemic stroke and, in 2015, guidelines recommended CTA when LVO is considered. CTP was added in 2018 for select patients. In the ED, the Emergency Medical Treatment and Labor Act (EMTALA) requires anyone presenting to be stabilized and treated, regardless of insurance status and should limit variability in advanced neuroimaging use based on insurance status. We examined ED stroke assessment disparities by evaluating national variability in the use of advanced stroke imaging by primary payer (Private Insurance, Medicare, Medicaid, Self-Pay). Methods: Retrospective cohort study using adult encounters admitted to the same hospital in the 2018 National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters. CTA (head/neck) and CTP imaging use was determined from Common Procedural Terminology (CPT) codes and adjusted by age. Rate per 100,000 ED visits were compared across primary payers using ANOVA with Tukey adjustment. Results: Age-adjusted CTP rates varied by payer but did not research statistical significance. Rates of CTA acquisition were significantly different across payer groups (p<0.001). See Table. Conclusion: Variability in age-adjusted rates of advanced neuroimaging use in the ED was identified. The variability for CTP, a unique ED imaging modality for stroke, was not significant, however interpretation is limited by confidence interval size. Variability in CTA was significant between groups and will undergo further analysis to evaluate for confounding by other patient or hospital factors.