Delays in treatment and disposition attributable to undertriage of pediatric emergency medicine patients

Authors

Deena Berkowitz, Division 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. Electronic address: dberkowitz@childrensnational.org.
Joanna S. Cohen, Division of Pediatric Emergency Medicine, Johns Hopkins University, United States of America; Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Nichole McCollum, Division 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.
Christina R. Rojas, Division 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.
James M. Chamberlain, Division 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.

Document Type

Journal Article

Publication Date

12-1-2023

Journal

The American journal of emergency medicine

Volume

74

DOI

10.1016/j.ajem.2023.09.054

Keywords

Admission; Emergency medicine; Pediatrics; Return visits; Triage; Undertriage

Abstract

BACKGROUND: Triage, the initial assessment and sorting of patients in the Emergency Department (ED), determines priority of evaluation and treatment. Little is known about the impact of undertriage, the underestimation of disease severity at triage, on clinical care in pediatric ED patients. We evaluate the impact of undertriage on time to disposition and treatment decisions in pediatric ED patients. METHODS: This was a case control study of ED visits for patients <22 years of age, with an assigned Emergency Severity Index (ESI) score of 4 or 5, and associated hospital admission, nebulized treatment, supplemental oxygen, and/or intravenous (IV) line placement, between January 1, 2018, to June 30, 2022. Controls were sampled from a pool of patient visits with an ESI score of 3, matched by intervention, disposition, and date and hour of arrival. Primary outcome measures were time to order of intervention (nebulized treatment, oxygen administration, or IV placement) and time to disposition decision. A secondary outcome measure was return visits requiring admission or emergency intervention within 14 days of the index visit. Continuous variables (time to orders) were analyzed using Wilcoxon rank sum test and dichotomous outcomes (return visits) were compared using odds ratios with 95% confidence intervals. Analysis was performed with Python v3.10. RESULTS: The final analysis included 7245 undertriaged patients. Undertriaged patients had longer times to orders for nebulized treatments, (p < 0.001) IV placement, (p < 0.001) and admission (p < 0.001) when compared to controls. There were no significant differences in time to supplemental oxygen delivery and time to discharge compared to controls. Undertriaged patients were more likely to experience a return visit requiring admission or emergency intervention (OR 3.74, 95% CI 3.32,4.22). CONCLUSIONS: Undertriage in the pediatric ED is associated with delays in care and disposition decisions and increases likelihood of return visits.

APA Citation

Berkowitz, Deena; Cohen, Joanna S.; McCollum, Nichole; Rojas, Christina R.; and Chamberlain, James M., "Delays in treatment and disposition attributable to undertriage of pediatric emergency medicine patients" (2023). GW Authored Works. Paper 3521.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3521

Department

Pediatrics