456 - The Use of Focused Cardiac Ultrasound in Adolescents Evaluated in the Emergency Department for Chest Pain or Syncope: Is There a Sex Discrepancy?

Focused cardiac ultrasound is often performed in patients with chest pain or syncope in the ED. It is possible that adolescent females are less likely to receive a focused cardiac ultrasound due to provider discomfort as adolescent females develop breast tissue.


Objective:

The primary aim of this study was to compare the number of focused cardiac ultrasounds obtained in adolescent males vs. females to determine if there is a difference. Secondary aims included determining if the apical four chamber (AP4C) view was more frequently obtained in males than females because of its proximity to breast tissue, looking at the sex of the ultrasound operator to determine if that affected whether or not they obtained the AP4C view, and evaluating the quality of images to determine if it was better in males vs. females.


Design/Methods:

This was a cross-sectional study that reviewed the EMR data of all the adolescent patients, ages 13-19, who had a chief complaint or diagnosis of chest pain or syncope from the year 2018-2020. Focused cardiac ultrasound scans obtained on this same cohort was reviewed. The patients were then identified by sex and compared to see if there were differences in the number of scans obtained based on the sex of the patient. The quality of the overall scans was also evaluated using a modified RACE protocol and compared to see if there was a sex-based difference. Descriptive statistics was calculated and differences assessed by sex using χ2 test.


Results:

A total of 2683 patients were enrolled in the study; 1022 were male and 1661 were female. Of those, 259 received focus cardiac ultrasounds; 132 (51%) were male and 127 (49%) were female. There was a significant difference in the percentage of patients who received focus cardiac ultrasounds, based on sex (p < .0001). There was no significant difference in the sex of the patients on whom the AP4C view was obtained. There was no significant association in the sex of the operator and whether or not they obtained the AP4C view on the patient. Finally, there was no significant difference in the sex of the patient and the quality of the images obtained. Interrater reliability between a PEM fellow who has had focused cardiac ultrasound training and a pediatric cardiologist was compared and yielded a kappa of 0.565.


Conclusion(s):

There was a significant difference in the sex of the patients who received a focused cardiac ultrasound for the complaint of chest pain or syncope. This could suggest a bias, either conscious or unconscious, on the part of the physicians evaluating these patients in the ED.