Racial and Ethnic Differences in Diagnostic Imaging Utilization During Adult Emergency Department Visits in the United States, 2005 to 2014.

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. 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. 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. We observed significant racial and ethnic differences in medical imaging use in the ED even after controlling for patient- and facility-level factors.

Schrager JD ，Patzer RE ，Kim JJ ，Pitts SR ，Chokshi FH ，Phillips JS ，Zhang X ... -  《-》

Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children's Hospitals, 2016-2019.

Marin JR ，Rodean J ，Hall M ，Alpern ER ，Aronson PL ，Chaudhari PP ，Cohen E ，Freedman SB ，Morse RB ，Peltz A ，Samuels-Kalow M ，Shah SS ，Simon HK ，Neuman MI ... -  《JAMA Network Open》

Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States.

Background: There is an incomplete understanding of disparities in emergency care for children across racial and ethnic groups in the United States. In this project, we sought to investigate patterns in emergency care utilization, disposition, and resource use in children by race and ethnicity after adjusting for demographic, socioeconomic, and clinical factors. Methods: In this cross-sectional study of emergency department (ED) data from the nationally representative National Hospital Ambulatory Medical Survey (NHAMCS), we examined multiple dimensions of ED care and treatment from 2005 to 2016 among children in the United States. The main outcomes include ED disposition (hospital admission, ICU admission, and in hospital death), resources utilization (medical imaging use, blood tests, and procedure use) and patient ED waiting times and total length of ED stay. The main exposure variable is race/ethnicity, categorized as non-Hispanic white (white), non-Hispanic black (Black), Hispanic, Asian, and Other. Analyses were stratified by race/ethnicity and adjusted for demographic, socioeconomic, and clinical factors. Results: There were 78,471 pediatric (≤18 years old) ED encounters, providing a weighted sample of 333,169,620 ED visits eligible for analysis. Black and Hispanic pediatric patients were 8% less likely (aOR 0.92, 95% CI 0.91-0.92) and 14% less likely (aOR 0.86, CI 0.86-0.86), respectively, than whites to have their care needs classified as immediate/emergent. Blacks and Hispanics were also 28 and 3% less likely, respectively, than whites to be admitted to the hospital following an ED visit (aOR 0.72, CI 0.72-0.72; aOR 0.97, CI 0.97-0.97). Blacks and Hispanics also experienced significantly longer wait times and overall visits as compared to whites. Conclusions: Black and Hispanic children faced disparities in emergency care across multiple dimensions of emergency care when compared to non-Hispanic white children, while Asian children did not demonstrate such patterns. Further research is needed to understand the underlying causes and long-term health consequences of these divergent patterns of racial disparities in ED care within an increasingly racially diverse cohort of younger Americans.

Zhang X ，Carabello M ，Hill T ，He K ，Friese CR ，Mahajan P ... -  《Frontiers in Pediatrics》

Association of Race/Ethnicity With Emergency Department Destination of Emergency Medical Services Transport.

Hanchate AD ，Paasche-Orlow MK ，Baker WE ，Lin MY ，Banerjee S ，Feldman J ... -  《JAMA Network Open》

Examining racial and ethnic disparities in adult emergency department patient visits for concussion in the United States.

Racial and ethnic differences in emergency department (ED) visits have been reported among adolescent patients but are unsubstantiated among adults. Therefore, our purpose in this study was to examine the relationship between race/ethnicity and adult ED visits for concussions, their injury mechanisms, and computed tomography (CT) scan use among a nationally representative sample. We used the National Hospital Ambulatory Medical Care Survey database from 2010-2015 to examine 63,725 adult (20-45 years old) patient visits, representing an estimated 310.6 million visits presented to EDs. Of these visits, 884 (4.5 million national estimate) were diagnosed with a concussion. Visit records detailed patient information (age, sex, race/ethnicity, geographic region, primary payment type), ED visit diagnoses, injury mechanism (sport, motor vehicle, fall, struck by or against, "other"), and head CT scan use. The primary independent variable was race/ethnicity (non-Hispanic Asian, non-Hispanic Black or African American, Hispanic/Latinx, non-Hispanic multiracial or another, and non-Hispanic White). We used multivariable logistic and multinomial regression models with complex survey sampling design weighting to examine the relationship between concussion ED visits, injury mechanisms, and CT scan use separately by race/ethnicity while accounting for covariates. There were no associations between race/ethnicity and concussion diagnosis among adult ED visits after accounting for covariates. Relative to sports-related injuries, non-Hispanic Black or African American patient visits were associated with a motor vehicle (OR = 2.69, 95% CI: 1.06-6.86) and "other" injury mechanism (OR = 4.58, 95% CI: 1.34-15.69) compared to non-Hispanic White patients. Relative to sports-related injuries, non-Hispanic Asian, multiracial, or patients of another race had decreased odds of falls (OR = 0.20, 95% CI: 0.04-0.91) and "other" injuries (OR = 0.09, 95% CI: 0.01-0.55) compared to non-Hispanic White patients. The odds of a CT scan being performed were significantly lower among Hispanic/Latinx patient visits relative to non-Hispanic White patients (OR = 0.52, 95% CI: 0.30-0.91), while no other race/ethnicity comparisons differed. Our findings indicate that the overarching concussion ED visit likelihood may not differ by race/ethnicity in adults, but the underlying mechanism causing the concussion and receiving a CT scan demonstrates considerable differences. Prospective future research is warranted to comprehensively understand and intervene in the complex, multi-level race/ethnicity relationships related to concussion health care to ensure equitable patient treatment.

Lempke LB ，Kerr ZY ，Melvin P ，Walton SR ，Wallace JS ，Mannix RC ，Meehan WP 3rd ，Ward VL ... -  《Frontiers in Neurology》