Abstract 13614: Nationwide Trends in Transcranial Doppler Utilization During Acute Ischemic Stroke Hospitalizations

Background: Trans-cranial Doppler (TCD), diagnostic ultrasound of the head and neck is a non-invasive, safe, and portable tool to assess dynamic cerebral blood flow. TCD allows us to explore the patient's neurocritical pathological features without invasive testing. Although TCD is portable and inexpensive compared to CT/MR angiograms, its utilization during AIS hospitalization is nonfrequent and unknown.

Aim: The aim of the study was to evaluate the patterns of TCD use during AIS hospitalizations.

Design/Methods: Data from the Nationwide Inpatient Sample (NIS-2003-2014) for adults (≥18 yr) were analyzed. Primary discharge diagnoses of AIS and TCD were identified using ICD-9-CM codes 433-436, 437.1, and 88.71, respectively. Cochran-Armitage trend test and multivariable survey logistic regression were utilized to evaluate TCD use and predictors.

Results: Of 4,224,924 patients identified with AIS 93,673 (2.22%) had TCD examination. There was a significant decline in utilization of TCD (3.84% in 2003 to 1.34% in 2014, p<0.0001). The patients with TCD utilization had a higher mean length of stay (6 vs 5 days; p<0.0001) and cost of hospitalization ($39,270 vs $38,100; p=0.0007) than non-TCD utilization. In multivariate regression analysis, age group 50-64 (aOR:1.55; 95%CI:1.28-1.88), 65-79 (1.66; 1.32-2.08), ≥80 (1.68; 1.29-2.18), African American (1.51; 1.45-1.58), Hispanic (1.63; 1.55-1.72), Asian/Pacific Islander (1.36; 1.26-1.47), zip income 76-100th percentile (1.24; 1.19-1.30), large bed size hospitals (1.44; 1.36-1.52), hypertension (1.05; 1.01-1.09), hypercholesterolemia (1.23; 1.18-1.29; p<0.0001), alcohol abuse (1.09; 1.00-1.18), anticoagulant use (1.47; 1.39-1.56), ischemic heart disease (1.05; 1.01-1.09), and ventricular septal defect (2.69; 1.31-5.52) have higher odds of TCD utilization. We have noticed lower odds of TCD utilization in elective admissions (0.65; 0.59-0.72). (c-statistic: 0.71)

Conclusions: Over the last decade, there has been a slight but steady decrease in the use of TCD during AIS hospitalizations in the US. Future studies should examine the cost-utility of TCD, especially with the advent of endovascular stroke treatment systems.