Abstract
Objective
To compare the use of medical imaging (x-ray [XR], CT, ultrasound, and MRI) in the
emergency department (ED) for adult patients of different racial and ethnic groups
in the United States from 2005 to 2014.
Methods
We performed a multilevel stratified regression analysis of the National Hospital
Ambulatory Medical Care Survey ED Subfile, a nationally representative database of
hospital-based ED visits. We examined race (white, black, Asian, other) and ethnicity
(Hispanic versus non-Hispanic) as the primary exposures for the outcomes of ED medical
imaging use (XR, CT, ultrasound, MRI, and any imaging). We controlled for other potential
patient-level and facility-level determinants of ED imaging use.
Results
Approximately half (48.8%) of the 225,037 adult patient ED visits underwent imaging;
36.1% underwent XR, 16.4% CT, 4.1% ultrasound, and 0.8% MRI. White patients received
imaging during 51.3% of their encounters, black patients received imaging during 43.6%
of their encounters, Asians received imaging during 50.8% of their encounters, and
other races received imaging during 46% of their encounters. As compared with white
patients, black patients had decreased adjusted odds of receiving imaging in the ED
(odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.84-0.89). Comparatively,
black patients had a lower odds of CT scan (OR = 0.80, 95% CI: 0.77-0.83) or MRI (OR =
0.74, 95% CI: 0.65-0.85). Hispanic patients and Asian patients had a higher odds of
receiving ultrasound (OR = 1.36, 95% CI: 1.27-1.44 and OR = 1.25, 95% CI: 1.10-1.42),
respectively.
Implications
We observed significant racial and ethnic differences in medical imaging use in the
ED even after controlling for patient- and facility-level factors.
Key Words
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References
- Assessing the nation’s progress toward elimination of disparities in health care.J Gen Intern Med. 2004; 19: 195-200
- Unequal treatment: confronting racial and ethnic disparities in health care.J Natl Med Assoc. 2002; 94: 666-668
- Health care disparities in emergency medicine.Acad Emerg Med. 2003; 10: 1176-1183
- Researching racial and ethnic disparities in emergency medicine.Acad Emerg Med. 2003; 10: 1169-1175
- Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004.Health Aff (Millwood). 2008; 27: w84-w95
- Racial disparities in emergency department length of stay for admitted patients in the United States.Acad Emerg Med. 2009; 16: 403-410
- Analgesic access for acute abdominal pain in the emergency department among racial/ethnic minority patients: a nationwide examination.Med Care. 2015; 53: 1000-1009
- Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.JAMA. 2008; 299: 70-78
- Disparities in the emergency department evaluation of chest pain patients.Acad Emerg Med. 2007; 14: 149-156
- Characteristics of ST elevation myocardial infarction patients who do not undergo percutaneous coronary intervention after prehospital cardiac catheterization laboratory activation.Crit Pathw Cardiol. 2016; 15: 16-21
- Diagnostic radiology resident and fellow workloads: a 12-year longitudinal trend analysis using national Medicare aggregate claims data.J Am Coll Radiol. 2015; 12: 664-669
- National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables.in: National Center for Health Statistics. Atlanta, GA, USA, Centers for Disease Control and Prevention2015
- Emergency department computed tomography utilization in the United States and Canada.Ann Emerg Med. 2013; 62: 486-94 e483
- Increased computed tomography utilization in the emergency department and its association with hospital admission.West J Emerg Med. 2017; 18: 835-845
- National trends in use of computed tomography in the emergency department.Ann Emerg Med. 2011; 58: 452-62 e453
- Analysis of factors influencing length of stay in the emergency department.CJEM. 2003; 5: 155-161
- Radiology utilization in the emergency department: trends of the past 2 decades.AJR Am J Roentgenol. 2014; 203: 355-360
- Medicare imaging demonstration final evaluation: report to congress.Rand Health Q. 2015; 5: 4
- Relationship of physician-identified patient race and ethnicity to use of computed tomography in pediatric blunt torso trauma.Acad Emerg Med. 2016; 23: 584-590
- Pediatric abdominal pain: use of imaging in the emergency department in the United States from 1999 to 2007.Radiology. 2012; 263: 778-785
- Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: key questions and answers.Ann Emerg Med. 2012; 60: 716-21 e711
- NHAMCS micro-data file documentation. 2004-2014.(Available at:) (Accessed April 1, 2018)
- Adjustments for center in multicenter studies: an overview.Ann Intern Med. 2001; 135: 112-123
- Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction.JAMA. 2004; 292: 1563-1572
- Ethnicity as a risk factor for inadequate emergency department analgesia.JAMA. 1993; 269: 1537-1539
- Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department.J Emerg Nurs. 2006; 32: 219-224
- Effect of ethnicity and race on the use of pain medications in children with long bone fractures in the emergency department.Ann Emerg Med. 2003; 42: 41-47
- Association of race/ethnicity with emergency department wait times.Pediatrics. 2005; 115: e310-e315
- Response rates and nonresponse errors in surveys.JAMA. 2012; 307: 1805-1806
- NHAMCS: does it hold up to scrutiny?.Ann Emerg Med. 2012; 60: 722-725
- A cross-sectional study of emergency department boarding practices in the United States.Acad Emerg Med. 2014; 21: 497-503
- Emergency department volume and racial and ethnic differences in waiting times in the United States.Med Care. 2012; 50: 335-341
Article Info
Publication History
Published online: May 16, 2019
Footnotes
J.S. is a founder of a software startup called Vital Software, Inc, which provides clinical decision support and predictive analytic services for the emergency department. The other authors state that they have no conflict of interest related to the material discussed in this article.
Identification
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© 2019 American College of Radiology
