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

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.
Nichole L. 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.
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

7-18-2025

Journal

The American journal of emergency medicine

Volume

97

DOI

10.1016/j.ajem.2025.07.039

Keywords

Emergency Severity Index (ESI); Pediatric emergency medicine; Triage; Undertriage

Abstract

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.

APA Citation

Berkowitz, Deena; McCollum, Nichole L.; and Chamberlain, James M., "Race, ethnicity, and language association with Undertriage in Pediatric emergency medicine" (2025). GW Authored Works. Paper 7564.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7564

Department

Pediatrics