Article Instance
API Endpoint for journals.
GET /api/articles/38462/?format=api
{ "pk": 38462, "title": "Multicenter Study Evaluating Impact of Patient and Sonographer Demographics on Quality of Focused Cardiac Ultrasounds", "subtitle": null, "abstract": "<p><strong>Introduction: </strong>Demographic inequities in cardiovascular care have been well established, with evidence of effects from sex, age, and body mass index (BMI). For instance, women are less likely to receive guideline-based care for acute myocardial Infarction, bystander cardiopulmonary resuscitation, or recognition of cardiac arrest. We investigated the impact of patient sex, along with other patient demographics such as age and BMI, on the quality of focused cardiac ultrasounds (FOCUS). We hypothesized that females would have lower overall FOCUS quality and more frequently omitted apical four-chamber (A4C) views due to breast tissue. Secondary objectives included evaluating differences in image quality and omission rates by BMI, and by age and sonographer sex and training level.</p>\n<p><strong>Methods:</strong> In this multicenter, retrospective study we investigated 1,200 total adult patients (100 females and 100 males per site) at six participating sites. The FOCUS quality was determined by two blinded experts per site using a 1-5 ordinal scale per view (parasternal long, parasternal short, A4C, and subxiphoid). The primary outcome, overall quality, was the summed score of the four views, with a maximum score of 20. This scale was then collapsed into three categories for the individual FOCUS views: images inadequate to support diagnosis; images meeting the minimum to support diagnosis; and images supporting the diagnosis well. Secondary outcomes were A4C quality and omission rate. We evaluated associations between sex and FOCUS overall quality using unadjusted mixed-effects models followed by multivariable mixed-effects models adjusted for patient age, BMI, operator sex, and operator experience level. </p>\n<p><strong>Results:</strong> The A4C images of female patients were of significantly lower quality (P < .001) and had been omitted more frequently (P < .001); male patients had > 60% higher odds of a diagnostic A4C view (95% CI 1.3 - 2.0). Overall FOCUS quality decreased as BMI deviated from normal and as age increased. There was no significant difference in overall FOCUS quality between female and male patients. </p>\n<p><strong>Conclusion:</strong> We did not find sex-based differences in overall FOCUS quality; however, we did find that females received lower quality apical four-chamber views and had this view omitted more frequently. Additionally, overall quality declined as BMI deviated from normal, and as age advanced. Future research should elucidate the clinical implications of these differences in quality and the explanation behind not obtaining high-quality views in older patients, in individuals whose BMI deviated from normal toward either underweight or overweight, or in female patients.</p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "sex" }, { "word": "gender" }, { "word": "health equity" }, { "word": "ultrasound" }, { "word": "FOCUS" }, { "word": "Cardiac" } ], "section": "Technology in Emergency Medicine", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5xs588sf", "frozenauthors": [ { "first_name": "Barret", "middle_name": "", "last_name": "Zimmerman", "name_suffix": "", "institution": "Harvard Medical School / Mass General Brigham, Department of Emergency Medicine, Boston, Massachusetts", "department": "" }, { "first_name": "Tracy", "middle_name": "E.", "last_name": "Madsen", "name_suffix": "", "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "" }, { "first_name": "Giorgina", "middle_name": "", "last_name": "Giampaolo", "name_suffix": "", "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "" }, { "first_name": "Jennifer", "middle_name": "", "last_name": "Rogers", "name_suffix": "", "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "" }, { "first_name": "Hilary", "middle_name": "", "last_name": "Davenport Stroud", "name_suffix": "", "institution": "The Ohio State University, Department of Emergency Medicine, Columbus, Ohio", "department": "" }, { "first_name": "Creagh", "middle_name": "Turner", "last_name": "Boulger", "name_suffix": "", "institution": "The Ohio State University, Department of Emergency Medicine, Columbus, Ohio", "department": "" }, { "first_name": "Michael", "middle_name": "I.", "last_name": "Prats", "name_suffix": "", "institution": "The Ohio State University, Department of Emergency Medicine, Columbus, Ohio", "department": "" }, { "first_name": "Alice", "middle_name": "", "last_name": "Wu", "name_suffix": "", "institution": "The Ohio State University, Department of Emergency Medicine, Columbus, Ohio", "department": "" }, { "first_name": "Megan", "middle_name": "", "last_name": "Leo", "name_suffix": "", "institution": "Boston University Chobanian & Avedisian School of Medicine, Department of Emergency Medicine, Boston, Massachusetts", "department": "" }, { "first_name": "Joseph", "middle_name": "", "last_name": "Pare", "name_suffix": "", "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "" }, { "first_name": "Meera", "middle_name": "", "last_name": "Muruganandan", "name_suffix": "", "institution": "Boston University Chobanian & Avedisian School of Medicine, Department of Emergency Medicine, Boston, Massachusetts", "department": "" }, { "first_name": "Josh", "middle_name": "", "last_name": "Kaine", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "" }, { "first_name": "Daniel", "middle_name": "S.", "last_name": "Brenner", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "" }, { "first_name": "Pam", "middle_name": "", "last_name": "Cruz Soriano", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "" }, { "first_name": "Nadia", "middle_name": "Aracelliz", "last_name": "Villarroel", "name_suffix": "", "institution": "Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts", "department": "" }, { "first_name": "Michele", "middle_name": "L.", "last_name": "Schroeder", "name_suffix": "", "institution": "Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts", "department": "" }, { "first_name": "Natalie", "middle_name": "", "last_name": "Strokes", "name_suffix": "", "institution": "Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts", "department": "" }, { "first_name": "Anna", "middle_name": "", "last_name": "Tyson", "name_suffix": "", "institution": "Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts", "department": "" }, { "first_name": "Timothy", "middle_name": "", "last_name": "Gleeson", "name_suffix": "", "institution": "Medicine, Springfield, Massachusetts UMass Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "" }, { "first_name": "MIchael", "middle_name": "", "last_name": "Hill", "name_suffix": "", "institution": "Medicine, Springfield, Massachusetts UMass Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "" }, { "first_name": "Janette", "middle_name": "", "last_name": "Baird", "name_suffix": "", "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "" }, { "first_name": "Alyson", "middle_name": "J.", "last_name": "McGregor", "name_suffix": "", "institution": "University of South Carolina School of Medicine / Prisma, Department of Emergency Medicine, Greenville, South Carolina", "department": "" }, { "first_name": "Kristin", "middle_name": "H.", "last_name": "Dwyer", "name_suffix": "", "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "" } ], "date_submitted": "2024-11-07T18:35:20.305000Z", "date_accepted": "2025-06-15T23:11:11.771000Z", "date_published": "2025-10-05T14:35:00Z", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/38462/galley/40024/download/" } ] }