Race, ethnicity, and language association with Undertriage in Pediatric emergency medicine

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.