Significant racial and ethnic differences exist in the use of medical imaging in the emergency department (ED), with patients of color having lower odds of receiving imaging compared with their white counterparts, according to a study published in the August issue of the Journal of the American College of Radiology.
The study findings demonstrate that there's more work to be done to uncover the reason for the disparities, wrote a group of researchers led by Dr. Justin Schrager of the Emory University School of Medicine in Atlanta.
"We observed a large racial difference with regard to how medical imaging is used in the ED even after controlling for patient- and facility-level factors," the team wrote (JACR, August 2019, Vol. 16:8, pp. 1036-1045). "These observed differences warrant further investigation to determine whether they reflect true racial disparities in patient care."
Previous studies have described racial and ethnic disparities in the ED, examples of which include black patients waiting longer to be seen and having longer stays and also patients of color receiving less pain management and medical testing. Schrager and colleagues sought to investigate whether racial and ethnic disparities exist in the use of x-ray, CT, ultrasound, and MRI in the ED.
The group used data from the National Hospital Ambulatory Medical Care Survey Emergency Department Subfile, a national database of hospital-based ED visits, from 2005 to 2014. Of 225,037 adult patient ED visits during the study time frame, 48.8% of the patients underwent imaging. Of these, 36.1% had x-ray exams, 16.4% underwent CT, 4.1% had ultrasound exams, and 0.8% underwent MRI.
But there were differences according to race and ethnicity, Schrager and colleagues found.
| Emergency department medical imaging use by modality and race | |||||
| Modality | White | Black | Hispanic | Asian | Other |
| Any imaging | 51.3% | 43.6% | 45.1% | 50.8% | 46% |
| CT | 17.8% | 13% | 14.9% | 18.2% | 15.9% |
| MRI | 0.8% | 0.6% | 0.7% | 1.1% | 0.7% |
| Ultrasound | 3.5% | 4.2% | 6.5% | 6% | 4% |
| X-ray | 38.3% | 32.8% | 31% | 36.6% | 32.9% |
Compared with white patients, black patients had decreased odds of receiving imaging in the emergency department, particularly CT and MRI exams. Hispanic and Asian patients had higher odds of receiving ultrasound scans, the researchers reported.
| Adjusted odds of undergoing imaging in the ED by modality and race | |||||
| Modality | White | Black | Hispanic | Asian | Other |
| Any imaging | 1 (reference) | 0.86 | 1.01 | 1.15 | 0.97 |
| CT | 1 | 0.80 | 0.99 | 1.10 | 1.02 |
| MRI | 1 | 0.74 | 0.89 | 1.12 | 0.84 |
| Ultrasound | 1 | 1.03 | 1.36 | 1.25 | 0.87 |
| X-ray | 1 | 0.96 | 0.98 | 1.16 | 0.98 |
Why the discrepancies? A number of factors could be at work, but more research is needed, according to the group.
"The interaction of race, insurance status, homelessness, and ED safety-net use is extremely complex," the study authors concluded. "The findings of several large observational studies of racial and ethnic disparities in ED care suggest that the underuse of key clinical resources by race and ethnicity in the ED is probably more likely. The ultimate cause of this underuse is both a topic for further research and a notable goal for process improvement within institutions."
