Abstract Details

Title Disparities in Pediatric Outpatient Office Visits After First-time Migraine-related Emergency Visit

Topic Headache

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-007

Objective To identify socioeconomic factors associated with rates of outpatient evaluation after a pediatric emergency department (ED) visit for migraine applying natural language processing to identify migraine through clinical notes.

Background Children of color are seen disproportionately in the ED for headache compared to those evaluated by outpatient neurology providers and are less likely to be assigned a migraine diagnosis, potentially impacting access to outpatient management.

Design/Methods We developed a language-learning model to identify migraine-related visits at one pediatric ED (sensitivity of model: 0.85; specificity: 0.69) trained on clinical notes from first-time visits with a chief complaint of headache and verified by chart review for patients ages 5-17 between January 2016 to February 2020. Analysis was restricted to patients with a primary pediatrician within our network. We calculated risk ratios for demographic and clinical traits for the likelihood of visiting an outpatient neurology or primary pediatric clinic within 6 months following their initial ED visit for migraine.

Results Across 3,622 headache visits, our model selected 1,595 children with migraine (43.2% male). We found a decreased likelihood of neurology evaluation for patients who were: male (RR 0.73 [95% CI 0.62-0.85]), Non-Hispanic Black (NHB; 0.65 [0.51-0.82]), or lacked private insurance (0.73 [0.59-0.90]). Follow-up with a primary pediatrician was more likely for NHB patients (1.23 [1.05-1.47]) and less likely for boys (0.78 [0.67-0.89]).

Conclusions NHB children, boys, and children without private insurance were less likely to see an outpatient neurologist within 6 months of an ED visit for migraine. However, NHB patients were more likely to see their primary pediatrician. Previous research found lower rates of specialized outpatient care for patients from marginalized backgrounds; however, our novel model identified patients by documented clinical presentation rather than billing diagnosis, potentially reducing selection bias. This study serves as proof-of-concept for using automated diagnostic tools in health outcomes research.

Authors/Disclosures
Christina L. Szperka, MD, FAAN (Children's Hospital of Philadelphia) PRESENTER	The institution of Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. The institution of Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. The institution of Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Szperka has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Upsher Smith. The institution of Dr. Szperka has received research support from PCORI. Dr. Szperka has a non-compensated relationship as a Cochair Scientific Committee with American Headache Society that is relevant to AAN interests or activities.
Danielle J. Kellier	The institution of Ms. Kellier has received research support from National Institute of Neurological Disorders and Stroke.
Marissa Anto, MD (The Children's Hospital of Philadelphia, Dept of Neurology)	Dr. Anto has nothing to disclose.
Mary Regina Boland (Saint Vincent College)	No disclosure on file
Craig A. Press, MD, PhD (Children's Hospital of Philadelphia)	Dr. Press has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Marinus Pharmaceuticals. Dr. Press has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Law Firms. Dr. Press has received research support from Marinus Pharmaceuticals. Dr. Press has received research support from Pediatric Epilepsy Research Foundation. Dr. Press has received research support from NIH.
Naomi Hughes (CHOP)	No disclosure on file
Svetlana Ostapenko	No disclosure on file
John T. Farrar, MD (Univ of PA Medical Center)	Dr. Farrar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Vertex Pharma. Dr. Farrar has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for PharamcoEpidemiology and Drug Safety. The institution of Dr. Farrar has received research support from Food and Drug Administration . The institution of Dr. Farrar has received research support from NIH .

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