Abstract TP163: Disparities in Toxicology Screening Among Stroke and TIA Patients: A Five-Year Retrospective Single Center Analysis

Introduction: An estimated 23.9 million (8.9%) individuals used illicit drugs and it accounted for 20 million disability-adjusted life-years in 2010. The use of illicit drugs, particularly cocaine, is associated with an increased risk of ischemic and hemorrhagic stroke. Given the lack of well-defined guidelines and previous literature suggesting healthcare disparities in toxicology screening, we aimed to determine the rate of urine toxicology screening and differences in testing among patients with stroke and transient ischemic attack (TIA) presenting to a tertiary care comprehensive stroke center. Hypothesis: We hypothesized that toxicology screening rates would differ depending on age, sex, and race. Methods: Approved by local ethics review board. All patients aged>18 admitted ischemic stroke, intracerebral hemorrhage, or TIA were included from 2018 to 2023. Demographic and clinical information were obtained from UMass Get With The Guidelines’ database. Charts were reviewed retrospectively to collect toxicology screening. The difference in urine toxicologies was assessed by chi-square tests for categorical measures and a 2-sample t-test for continuous measures. Univariate factors with a p<0.20 were included in multivariate logistic regression model. Results: A total of 4,511 stroke patients were identified, of whom 407 (9%) underwent toxicology screening. After excluding prescribed and hospital-administered medications, 90 patients (22.1%) had a positive toxicology result. The majority of tests (67.7%) were ordered by the admitting team, while 32.3% in the emergency department. A 9.3% cocaine positivity rate was observed in screened patients aged 50 to 69. Toxicology screening was performed significantly more often in patients under the age of 50, males, and individuals of Black race (p < 0.0001). No significant difference in the rate of positive results among these groups. Conclusions: Our results showed a significant positivity rate despite a low utilization of toxicology screening, revealing potential missed opportunity in the identification of illicit drugs for evaluation of stroke etiology and secondary stroke prevention, as well as a significant disparity towards testing young, male, and/or black patients. Screening disparities by age, sex, and race raise concerns about equity in stroke care. Standardized toxicology screening protocols for all stroke/TIA patients could improve etiologic evaluation and reduce demographic-based disparities.