Black patients with a nonspecific diagnosis are less likely to receive appropriate diagnostic tests in the emergency department than white patients, according to a study published online August 27. JAMA network opened.
Michael I. Ellenbogen, MD, of the Johns Hopkins School of Medicine in Baltimore, and colleagues used a previously validated diagnostic intensity index to assess differences in diagnostic testing rates by race and ethnicity in an acute care setting. The study included emergency department discharges, hospital observation stays, and hospital admissions from administrative claims in emergency departments and acute care hospitals in Kentucky, Maryland, North Carolina, and New Jersey from 2016 to 2018. To estimate rates of nondiagnostic testing, nonspecific principal diagnoses at discharge (nausea and vomiting, abdominal pain, chest pain, and syncope) were paired with related diagnostic tests.
Most (80.6%) of the 3,683,055 patients in the study were emergency department discharges. The researchers found that black patients discharged from the emergency department with a diagnosis of interest had an adjusted odds ratio of 0.74 for corresponding diagnostic testing compared with white patients. No other racial or ethnic disparities of similar magnitude were observed in any of the acute care settings.
“White patients discharged from the emergency department had a higher rate of nondiagnostic testing, suggesting higher test overuse. Although testing was less overused in black patients, there may be a risk of underdiagnosis and misdiagnosis,” the authors write.
One author claimed to be the inventor of a provisional patent for a smartphone-based stroke diagnosis in patients with dizziness and also to receive grants from industry.
Further information:
Michael I. Ellenbogen et al, Race and ethnicity and diagnostic testing for common conditions in the acute care setting, JAMA network opened (2024). DOI: 10.1001/jamanetworkopen.2024.30306
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