Patient Sociodemographic Factors Are Associated with Receiving Point-of-care Ultrasound in the Emergency Department

Point-of-care ultrasound (POCUS) is widely used in emergency medicine (EM) and increasingly throughout healthcare. Prior studies have revealed disparities in the use of imaging in the emergency department (ED) based on sociodemographic factors; however, the association between these factors and POCUS use is unknown. Our aim was to compare the odds of receiving POCUS in the ED based on patient race and ethnicity, language, sex, and type of insurance.

We reviewed electronic health records (EHR) matched to a departmental POCUS database from November 2021-June 2023 at an academic Level I trauma center. We included ED patients diagnosed with an International Classification of Diseases code mapped to chest or flank pain, who had a cardiac troponin obtained, or had been evaluated as a trauma activation or alert. Our primary outcome was whether a patient received transthoracic echocardiography (cardiac), renal, or focused assessment with sonography in trauma. Predictor variables were race/ethnicity group (non-Hispanic [NH] White, NH Black, Hispanic, other), patient language, sex assigned at birth, and insurance type as recorded in the EHR. We performed descriptive analyses and logistic regression (adjusted odds ratio [aOR], 95% confidence interval [CI]) controlling for body mass index, age, comorbidities, and triage hypotension or tachycardia.

Of the 25,389 ED patients meeting inclusion criteria, 79.5% were NH White, 95.3% listed English as their primary language, 51.5% were female, and 33.4% had private payor insurance. After adjusting for confounding, patients had lower odds of receiving POCUS if they were "other" race/ethnicity as compared to NH White (aOR 0.65, CI 0.42-0.99, P = .04), female as compared to male (aOR 0.81, CI 0.69-0.94, P = .007), or if they had Medicare (aOR 0.67, CI 0.54-0.84, P <.001) or Medicaid (aOR 0.66, CI 0.52-0.83, P = .001) as compared to private payors.

Overall, patients of female sex and patients with Medicaid or Medicare had lower odds of receiving point-of-care ultrasound in the ED. Although we did not find a difference in POCUS use among non-Hispanic White, NH Black, and Hispanic patients, patients belonging to other race/ethnicity categories had lower odds of receiving POCUS compared to NH White patients.