Background: to examine factors associated with cardiac evaluation and associations between cardiac test abnormalities and clinical outcomes in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), spontaneous subarachnoid hemorrhage (SAH), spontaneous intracerebral hemorrhage (sICH), and traumatic brain injury (TBI) requiring neurocritical care. Methods: In a cohort of patients ≥18 years, we examined the utilization of electrocardiography (ECG), beta-natriuretic peptide (BNP), cardiac troponin (cTnI), and transthoracic echocardiography (TTE). We investigated the association between cTnI, BNP, sex-adjusted prolonged QTc interval, low ejection fraction (EF < 40%), all-cause mortality, death by neurologic criteria (DNC), transition to comfort measures only (CMO), and hospital discharge to home using univariable and multivariable analysis (adjusted for age, sex, race/ethnicity, insurance carrier, pre-admission cardiac disorder, ABI type, admission Glasgow Coma Scale Score, mechanical ventilation, and intracranial pressure [ICP] monitoring). Results: The final sample comprised 11,822 patients: AIS (46.7%), sICH (18.5%), SAH (14.8%), and TBI (20.0%). A total of 63% (n = 7472) received cardiac workup, which increased over nine years (p < 0.001). A cardiac investigation was associated with increased age, male sex (aOR 1.16 [1.07, 1.27]), non-white ethnicity (aOR), non-commercial insurance (aOR 1.21 [1.09, 1.33]), pre-admission cardiac disorder (aOR 1.21 [1.09, 1.34]), mechanical ventilation (aOR1.78 [1.57, 2.02]) and ICP monitoring (aOR1.68 [1.49, 1.89]). Compared to AIS, sICH (aOR 0.25 [0.22, 0.29]), SAH (aOR 0.36 [0.30, 0.43]), and TBI (aOR 0.19 [0.17, 0.24]) patients were less likely to receive cardiac investigation. Patients with troponin 25th–50th quartile (aOR 1.65 [1.10–2.47]), troponin 50th–75th quartile (aOR 1.79 [1.22–2.63]), troponin >75th quartile (aOR 2.18 [1.49–3.17]), BNP 50th-75th quartile (aOR 2.86 [1.28–6.40]), BNP >75th quartile (aOR 4.54 [2.09–9.85]), prolonged QTc (aOR 3.41 [2.28; 5.30]), and EF < 40% (aOR 2.47 [1.07; 5.14]) were more likely to be DNC. Patients with troponin 50th–75th quartile (aOR 1.77 [1.14–2.73]), troponin >75th quartile (aOR 1.81 [1.18–2.78]), and prolonged QTc (aOR 1.71 [1.39; 2.12]) were more likely to be associated with a transition to CMO. Patients with prolonged QTc (aOR 0.66 [0.58; 0.76]) were less likely to be discharged home. Conclusions: This large, single-center study demonstrates low rates of cardiac evaluations in TBI, SAH, and sICH compared to AIS. However, there are strong associations between electrocardiography, biomarkers of cardiac injury and heart failure, and echocardiography findings on clinical outcomes in patients with ABI. Findings need validation in a multicenter cohort.

Objectives: To preliminarily compare health care utilization, sexual behaviors, and sexual health outcomes among high school students accessing school-based health centers (SBHCs) vs. non-SBHCs and develop an initial hypothesis on the potential impact of SBHCs. Design: Retrospective chart review. Setting: Three SBHC locations and 5 non-SBHCs locations within an adolescent and young adult health center system in Houston, Texas. Participants: Random sample of 189 high school students receiving care between August 2022 and May 2023 at a SBHC (n = 129) or non-SBHCs (n = 60). Main Outcome Measure: Demographic characteristics, health center utilization patterns, sexual behaviors, and sexual health outcomes, including sexually transmitted infection (STI) testing and results. Results: Students accessing SBHCs were more likely to be male (35.9% vs. 21.7%, P = .03) and Spanish-speaking (24.8% vs. 8.3%, P = .01) compared with students accessing non-SBHCs. Students accessing SBHCs also tended to be uninsured at higher rates (70.3% vs. 54.7%, P = .06), although the difference was not statistically significant. SBHC users were less likely to report having a primary care provider (22.5% vs. 41.7%, P = .01) or being sexually active (30.2% vs. 60.0%, P < .001). No significant differences were observed in STI testing rates or STI outcomes between groups. Conclusions: These preliminary data show that SBHCs serve adolescents with greater structural barriers to health care, including lack of insurance and limited access to primary care. SBHCs can be accessible points of care within schools that address disparities in health care access. Continued investment and expansion of SBHCs may have positive implications strengthen public health systems by improving access to preventive and sexual health services for underserved youth. Further research is needed to explore correlations between student utilization of health care to SBHC access.