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Racial Differences in Pediatric Emergency Department Triage Scores
Heather G Zook1, Anupam B Kharbanda2, Andrew Flood1
1Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
Insights
Racial disparities persist in pediatric emergency care. African American, Hispanic, and American Indian children received lower triage scores than White children, even after accounting for other factors.
Area of Science:
- Emergency Medicine
- Health Disparities Research
- Pediatric Care
Background:
- Racial disparities are a documented issue in emergency department (ED) care.
- Understanding these disparities in pediatric EDs is crucial for equitable healthcare delivery.
Purpose of the Study:
- To investigate racial differences in triage scores among pediatric patients in emergency departments.
- To determine if observed racial differences in triage scores persist after adjusting for sociodemographic and clinical factors.
Main Methods:
- Analysis of 54,505 visits to two urban pediatric EDs from August 2009 to March 2010.
- Electronic extraction of demographic and clinical data from medical records.
- Logistic regression used to analyze racial differences in triage scores, controlling for covariates.
Main Results:
- African American, Hispanic, and American Indian patients had significantly lower triage scores than White patients, even after adjustment (aORs ranging from 1.77 to 2.57).
- These disparities were particularly evident for presenting complaints of breathing difficulty, abdominal pain, and fever.
- Among hospitalized patients, African American and Hispanic patients also received lower-acuity triage scores compared to White patients.
Conclusions:
- Adjusting for available sociodemographic and clinical factors did not eliminate racial differences in pediatric ED triage scores.
- African American, Hispanic, and American Indian children are more likely to receive lower-acuity triage scores than White children.
- These findings highlight persistent racial disparities in the initial assessment of pediatric patients in emergency settings.
Background:
Racial disparities are frequently reported in emergency department (ED) care.
Objectives:
To examine racial differences in triage scores of pediatric ED patients. We hypothesized that racial differences existed but could be explained after adjusting for sociodemographic and clinical factors.
Methods:
We examined all visits to two urban, pediatric EDs between August 2009 and March 2010. Demographic and clinical data were electronically extracted from the medical record. We used logistic regression to analyze racial differences in triage scores, controlling for possible covariates.
Results:
There were 54,505 ED visits during the study period, with 7216 (13.2%) resulting in hospital admission. White patients accounted for 36.4% of visits, African Americans 28.5%, Hispanics 18.0%, Asians 4.1%, and American Indians 1.8%. After adjusting for potential confounders, African American (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.69-2.12), Hispanic (aOR 1.77, 95% CI 1.55-2.02), and American Indian (aOR 2.57, 95% CI 1.80-3.66) patients received lower-acuity triage scores than Whites. In three out of four subgroup analyses based on presenting complaints (breathing difficulty, abdominal pain, fever), African Americans and Hispanics had higher odds of receiving low-acuity triage scores. No racial differences were detected for patients with presenting complaints of laceration/head injury/arm injury. However, among patients admitted to the hospital, African Americans (aOR 1.47, 95% CI 1.13-1.90) and Hispanics (aOR 1.71, CI 1.22-2.39) received lower-acuity triage scores than Whites.
Conclusion:
After adjusting for available sociodemographic and clinical covariates, African American, Hispanic, and American Indian patients received lower-acuity triage scores than Whites.
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