Inequities in imaging: The association between patient demographics and use of point-of-care ultrasound in the ED

Background

Point-of-care ultrasound (POCUS) is a key diagnostic test in the emergency department (ED), especially in hypotensive patients. While bias exists throughout the health care system, it is unknown if these disparities also influence the use of POCUS. This study aimed to determine whether POCUS use in ED patients with hypotension varies based on demographic factors.

Methods

This was a retrospective analysis of visits to five EDs over five years. Adult patients with hypotension (systolic blood pressure less than 90 mmHg) were included. The primary outcome was whether a critical POCUS exam was performed. Critical POCUS included cardiac, thoracic, deep vein thrombosis, abdominal fluid (FAST), or aortic exams. We constructed a generalized linear mixed model to examine differences in the odds of receiving a critical POCUS exam between demographic groups.

Results

There was no significant difference in the odds of receiving a critical POCUS exam between racial/ethnic groups. However, female patients (aOR: 0.74, 95 % CI [0.70–0.78]) and patients with public insurance (aOR: 0.92, 95 % CI [0.86–0.99]) had significantly lower odds of receiving POCUS compared to male patients and those with private insurance, respectively.

Conclusions

There was no significant difference in POCUS use between racial/ethnic groups in this cohort. However, female patients and those with public insurance were at lower odds of receiving a POCUS exam. Additional research is needed to explore the causes of these disparities.