Social vulnerability and triage acuity among pregnant people seeking unscheduled hospital care.

Abstract

Objectives: This study examines the association between census tract-linked social vulnerability index (SVI) and maternal-fetal triage index (MFTI), a standardized score used to classify obstetric triage visit acuity.

Methods: This retrospective cohort study included patients at 20 weeks of gestational age or greater presenting to a New York City obstetric triage unit from March 2019 to April 2021, analyzing only the first pregnancy per patient. Exclusions included missing SVI or MFTI data and MFTI-5 (scheduled services). The primary exposure was SVI, and the primary outcome was MFTI score at the first triage visit. Multinomial logistic regression modeled the odds of MFTI-1 (stat) and MFTI-2 (urgent) visits relative to prompt/non-urgent visits, adjusting for potential confounders.

Results: Among 11,388 pregnant patients, most triage visits were classified as prompt or non-urgent (61.5 %), while 35.1 % were urgent, and 3.4 % were stat. Patients from neighborhoods with very high SVI had increased odds of an urgent visit (aOR 1.22, 95 % CI 1.06-1.41), as did those with chronic hypertension (aOR 1.46, 95 % CI 1.18-1.81), though SVI was not associated with stat visits. Stat visits were more likely during the COVID-19 pandemic (aOR 5.42, 95 % CI 4.04-7.28) and among patients with chronic hypertension (aOR 1.84, 95 % CI 1.15-2.94), while nulliparity and term presentation were associated with lower odds of a stat visit.

Conclusions: Patients living in areas with a very high SVI score had increased odds of urgent triage visits but not stat visits. No racial or ethnic disparities were observed.