Abstract Details

Title Social Determinants of MRI-driven Management Changes in Infective Endocarditis: The Role of Insurance, Homelessness, and Intravenous Drug Use

Topic Infectious Disease

Presentation(s) S9 - Neuroinfectious Disease: Associations and Outcomes (4:54 PM-5:06 PM)

Poster/Presentation
Number 008

Objective We hypothesized that insurance status, homelessness, and intravenous drug use (IVDU) significantly influence the likelihood of diagnostic and management changes following brain MRI or MRA in patients with infective endocarditis (IE) presenting with neurologic complications.

Background IE often affects socially and economically marginalized populations with homelessness and IVDU being major risk factors. Neurologic complications occur in up to 55% of cases and worsen outcomes, yet current guidelines do not consistently recommend neuroimaging. Limited evidence exists on how social determinants affect the utilization and clinical impact of MRI/MRA in IE.

Design/Methods We retrospectively analyzed the EMR data of 374 IE patients (2014–23) at a large urban safety-net hospital. Among them, 162 underwent brain MRI or MRA. Provider documentation before and after MRI was reviewed to identify changes in diagnosis, medication, or surgical management. Logistic regression assessed associations between these outcomes and homelessness, IVDU, and insurance type (α = 0.05).

Results MRI findings led to diagnostic modifications in 78.9% of cases, medical management changes in 54.9%, and surgical changes in 16.6%. Uninsured patients had greater odds of diagnostic modification (OR = 7.66, p = 0.05), and privately insured patients had higher odds of medical management change (OR = 4.92, p = 0.045). IVDU was associated with a trend toward increased surgical intervention (OR = 2.26, p = 0.085). Homelessness showed no significant association with diagnostic or management changes.

Conclusions Insurance type and IVDU status are strongly correlated with how imaging findings are translated into medical or surgical interventions. Future studies should explore the possible reasons for these association.

Authors/Disclosures
Shreya Tripathy PRESENTER	Ms. Tripathy has nothing to disclose.
Meha Prabhu	Miss Prabhu has nothing to disclose.
Steven K. Feske, MD (Boston Medical Center, Neurology Department)	Dr. Feske has received publishing royalties from a publication relating to health care.

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