Racial inequities in point-of-care ultrasound for pregnancy

Racial inequities are pervasive throughout healthcare. We sought to assess if race and ethnicity are associated with emergency department (ED) point-of-care ultrasound (POCUS) usage compared with radiology-ordered ultrasounds as our primary outcome and a secondary outcome of nurse-driven ultrasound ordering for early pregnancy.

In this retrospective, observational cohort study between June 2015 and December 2021, we assessed ED physician POCUS use in relation to Radiology (RADUS) ultrasound for first trimester pregnancy with race and ethnicity as our primary variable. A secondary outcome assessed if race and ethnicity impacted nursing-driven ultrasound ordering. Univariate and multivariate logistic regression models were created to test relationships and interactions with clinical variables. Given the overlap of language and race/ethnicity, a multivariate model with language as the primary variable was included.

No significant differences based on race and ethnicity were found for the selection of POCUS versus RADUS (n = 2337: χ2 = 5.25, p = 0.155). For the secondary outcome, 1694 of 7662 (22.1 %) patients received a nurse ultrasound order. Hispanic/Latino patients had increased odds of receiving a nurse-driven order (aOR 1.25, 95 % CI 1.009-1.549) and those of other or unknown race/ethnicity (aOR 1.357, 95 %CI 1.043-1.765) when language was excluded; in addition to Non-English speakers (OR 1.213, 95 %CI 1.072-1.372) with race excluded.

For first trimester pregnancy complaints, race and ethnicity did not alter POCUS usage by ED physicians. Secondary analysis showed race and ethnicity differences in nurse-driven orders, however collinearity between the primary outcome and language makes it difficult to assess the magnitude of these factors.