Abstract Details

Title Disparities in the Evaluation and Treatment of Pediatric Migraine in the Emergency Department Using a Language-learning Model

Topic Headache

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 12-007

Objective To examine racial/ethnic disparities in migraine diagnosis and management in the pediatric emergency department (ED) using a natural language processing model to identify migraine independent of billing diagnosis.

Background Children of color (CoC) received fewer migraine diagnoses in the ED leading to selection bias in studies of patients with migraine diagnoses. Less biased identification may help with health equity research.

Design/Methods We developed a language-learning model to identify migraine in headache-related visits at one pediatric ED (sensitivity of model: 0.85; specificity: 0.69). This model was trained on ED clinical notes for first-time visits of patients ages 5-17 with a headache chief complaint between January 2016 and February 2020 and validated by chart review. We calculated risk ratios for migraine billing diagnosis, testing, and treatment for non-Hispanic Black (NHB) and Hispanic/Latino (HL) patients compared to non-Hispanic White (NHW) patients, adjusting for demographics and medical comorbidities.

Results Across 6,718 headache visits, our model identified 3,567 visits (41.3% male) for migraine although only 29.8% of those received a migraine billing diagnosis. Among those identified by the model as having migraine, a lower proportion of CoC received migraine diagnoses (NHB vs. NHW: RR 0.80 [95% CI 0.71-0.92]; HL vs. NHW: 0.72 [0.55-0.95]). A lower proportion of NHB children received any blood tests (NHB: 0.81 [0.72-0.95]; HL: 1.01 [1.00-1.19]), brain MRI scans (NHB: 0.81 [0.64-0.98]; HL: 1.29 [0.92-1.61]), or intravenous medications (NHB: 0.78 [0.72-0.85]; HL: 1.00 [0.94-1.03]).

Conclusions CoC presenting with migraine in the ED received fewer migraine diagnoses and lower rates of blood tests, neuroimaging, and intravenous medications compared to NHW children. This disparity in migraine diagnosis aligns with previous research based on headache diagnosis; however, our novel model classifies patients by documented clinical presentation potentially reducing selection bias. Further validation of such automated diagnostic tools will be critical for both more equitable research and clinical care.

Authors/Disclosures
Christina Szperka (Pediatric Headache Program and Department of Neurology, Perelman School of Medic) PRESENTER	No disclosure on file
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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