What question did this study set out to answer?

To evaluate the reporting and representation of race and ethnicity in U.S. acute interventional neurology trials, highlighting underrepresentation of minorities.

May 7, 2026Open Access

Unveiling Reporting & Representation of Race and Ethnicity in Acute Interventional Neurology Trials: A Systematic Review

Key Points

To evaluate the reporting and representation of race and ethnicity in U.S. acute interventional neurology trials, highlighting underrepresentation of minorities.
Systematic review of U.S. phase II–IV acute neurology trials from MEDLINE/Embase (07/1990-12/2025) reporting race or ethnicity.
Screened and extracted data from 379 articles, resulting in 24 eligible trials.
Categorized race and ethnicity data from a total cohort of 10,811 patients.
Only 17.4% of trials reported the source of race and ethnicity classification, with 75% self-reported.
White individuals accounted for over 50% of participants in 79% of trials, indicating a lack of diversity.
Acute ischemic stroke trials showed variable reporting of Black patients, ranging from 0% to 29%.

Abstract

Underreporting and underrepresentation of racial and ethnic minorities limit trial generalizability. This issue is documented in stroke but less clear among other acute neurology trials. We assessed race and ethnicity reporting in U.S. acute neurology trials, hypothesizing inconsistent reporting/underrepresentation of disproportionately affected groups. Systematic review of MEDLINE/Embase (07/1990-12/2025) identifying adult U.S. phase II–IV acute neurology trials reporting race and/or ethnicity. Two reviewers screened/extracted data using Covidence®. Of 379 full-text articles, 27 (7%) otherwise eligible trials were excluded for lacking race and/or ethnicity data (n=6798): 15 covered acute ischemic stroke (AIS), 5 subarachnoid hemorrhage (SAH), 1 intracerebral hemorrhage (ICH), 2 traumatic brain injury, 3 seizures/status epilepticus (SE), and 1 encephalitis. The final cohort included 24 trials (n=10,811; 1999-2025): AIS (12), ICH/intraventricular hemorrhage (IVH) (6), SAH (4), and seizures/SE (2). Race included White in 23 (96%), Black/African American in 18 (75%), Asian in 10 (42%), American Indian/Alaska Native in 3 (13%), and Native Hawaiian/Other Pacific Islander in 1 (4%). Ethnicity was reported in 15, with 10 (67%) using it interchangeably with race. White individuals comprised >50% of patients in 19 (79%) trials. Six (26%) used non-standard/outdated categories. Only 17.4% reported who classified race and ethnicity (75% being self/family-reported). ICH/IVH trials largely matched epidemiology (5/6), with Black representation up to 56.2% and Asian 15–18%. AIS varied: 4 lacked Black patients; 6 reported 7–13%; 2 reported 17 and 29%; and 5 lacked Hispanic patients (otherwise 2–24%). SAH trials reported Black and Hispanic patients 7–28% and 6–32%, respectively, with ethnicity absent in 2/4. SE trials reported Black patients between 21–26%. Race and ethnicity reporting in acute neurology trials remains inconsistent and frequently misaligned with incidence patterns. Given higher disease burden among Black and Hispanic individuals, improved reporting and recruitment are needed for equitable representation.

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Cite This Study

Comparan et al. (Wed,) studied this question.

synapsesocial.com/papers/69fc2ba98b49bacb8b347abd https://doi.org/https://doi.org/10.1016/j.neuros.2026.100041

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