Prevalence of Stigmatizing Language in the Triage Documentation of Patients Presenting to the Emergency Department with Pain

Abstract

Background

Stigmatizing language in medical documentation is prevalent and associated with race, gender, age, and weight. Triage documentation may impart an outsized effect on downstream care, communicating information to other clinicians prior to their own evaluation.

Objective

The goal of this study was to determine the prevalence of stigmatizing language in triage notes for pain-related emergency department (ED) visits.

Methods

We performed a cross-sectional study at an urban academic ED. Triage notes between 2017 and 2021 for patients presenting with chest, abdominal, headache, back and injury-related pain were extracted from the electronic health record. A lexicon of stigmatizing words was created a priori from existing literature. Descriptive statistics were used to report the frequency of stigmatizing language by pain type, demographics, and acuity (Emergency Severity Index, ESI). Logistic generalized estimating equations were used to estimate the association between these covariates and stigmatizing language.

Results

A total of 51,570 ED visits were included. 2691 triage notes (5.2%) contained at least one stigmatizing word. Male gender (OR: 1.21 95%CI [1.12, 1.31]), Black race (1.11 [1.01, 1.23]), Medicaid (1.29 [1.17, 1.44]) and Medicare (1.22 [1.11, 1.34) insurance were associated with higher odds of stigmatizing language. Back (0.58 [0.49, 0.69]) and injury-related (0.54 [0.47, 0.62]) pain were associated with lower odds compared to visits for abdominal pain. Lower acuity visits (ESI-3 0.77 [0.70, 0.84] and ESI-4 0.52 [0.42, 0.64]) were associated with lower odds when compared to ESI-2.

Conclusions

Stigmatizing language is present in roughly 1 in 20 visits for pain and is disproportionality prevalent in males, Black patients, and those with government insurance.