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Race, ethnicity, and language association with Undertriage in Pediatric emergency medicine
Deena Berkowitz1, Nichole L McCollum1, James M Chamberlain1
1Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
Insights
Pediatric undertriage is more common in White, Hispanic, and non-English speaking patients, contrasting with previous research on emergency care disparities. Further investigation into these complex factors is crucial.
Area of Science:
- Emergency Medicine
- Health Disparities Research
- Pediatric Trauma Care
Background:
- Undertriage in emergency medicine delays critical care.
- Disparities in pediatric undertriage are not well-studied.
- Understanding these disparities is vital for equitable patient outcomes.
Purpose of the Study:
- To investigate if minoritized populations experience higher rates of undertriage in pediatric emergency care.
- To identify specific demographic factors associated with undertriage.
Main Methods:
- A cohort study analyzed pediatric patient visits at Level 1 Pediatric Trauma and regional referral centers.
- Clinically important undertriage was defined using a modified Delphi approach (ESI scores 4-5 with specific interventions).
- Exposures included patient race, ethnicity, and caregiver language preference.
Main Results:
- Non-Hispanic White patients showed higher odds of undertriage compared to Non-Hispanic Black patients (aOR 2.1).
- Hispanic patients also had increased odds of undertriage versus Non-Hispanic Black patients (aOR 1.7).
- Patients/caregivers preferring Spanish or other non-English languages faced higher undertriage odds (aORs 1.6 and 1.5).
Conclusions:
- Findings challenge prior research indicating Black patients are at highest risk for undertriage.
- Results underscore the complex and multifaceted nature of healthcare disparities.
- Further research is essential for a nuanced understanding of inequitable care drivers.
Importance:
Undertriage in emergency medicine impacts timeliness to care delivery. Limited research examines disparities in pediatric undertriage.
Objective:
To assess whether minoritized populations are more likely to experience undertriage.
Design/Setting/Participants:
This cohort study analyzed pediatric patient visits to a Level 1 Pediatric Trauma center and regional referral center from July 1, 2021, and September 16, 2024.Clinically important undertriage was defined using a modified Delphi approach, as Emergency Severity Index (ESI) scores of 4 or 5 in patients who were admitted or received intravenous medications, nebulized medications, or oxygen. Exposures were patient race, ethnicity and caregiver language preference. The primary outcome was clinically important undertriage.
Results:
In comparison to NH Black patients, NH White patients were more likely to be undertriaged (odds ratio [OR],2.0; 95 % CI, 1.7-2.3). After multivariable adjustment, this association remained significant (adjusted OR [aOR], 2.1; 95 % CI, 1.8-2.4). Similarly, Hispanic patients had higher odds of undertriage compared to NH Black patients (aOR, 1.7;95 % CI,1.6-1.8). Patients and caregivers preferring Spanish or other non-English languages had increased odds of undertriage; (aOR,1.6;95 % CI,1.5-1.7; and aOR 1.5 (95 % CI [1.1-1.9]), respectively.
Conclusions And Relevance:
These findings contrast with prior studies suggesting NH Black patients are at highest risk for undertriage and highlight the complexity of care disparities. Further research is needed for a more nuanced understanding of the factors driving inequitable care.
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