WIP 107 - Is there an association between race/ethnicity and undertriage in a pediatric emergency department?

Poster Number: WIP 107
Publication Number: WIP 107.888

Background: Most United States emergency departments (EDs) utilize the Emergency Severity Index (ESI) for the purposes of triage, which assigns each patient a numerical score ranging from 1 (most severe) to 5 (least severe) to indicate urgency of evaluation and intervention. The algorithm involves a combination of objective and subjective assessments, and recent research has suggested its potential to be influenced by bias. Several general ED-based studies have found evidence of racial disparities, with most demonstrating an overall pattern of non-white patients being more likely to be triaged to less severe ESI scores compared to white patients. More pediatric studies assessing the existence of racial and ethnic disparities in the triage process are needed to critically appraise the widespread use of the ESI.

Objective: To assess for an association between race/ethnicity and undertriage in a pediatric ED.

Design/Methods: We will conduct a retrospective cross-sectional study of ED visits at a large, urban, quaternary pediatric emergency department between January 2018 through August 2023. All patients with ESI scores 2-5 who were admitted to the inpatient unit or operating room will be included. Patients with ESI 1 will be excluded as they are generally the most obviously critically ill and therefore presumed to be less subject to systemic bias. Undertriage will be defined as being classified as ESI 4 or 5 and requiring admission from the ED. We will perform a logistic regression to evaluate the association between race/ethnicity and undertriage, controlling for demographics and insurance status. Results will be reported as odds ratios with 95% confidence intervals. This study has been approved by the IRB. A data retrieval request was submitted and we anticipate completion of statistical analysis by December 31, 2023.