The following is a summary of “Patient sex, racial and ethnic disparities in emergency department triage: A multi-site retrospective study,” published in the February 2024 issue of Emergency Medicine by Patel, et al.

For a study, researchers sought to investigate potential disparities based on sex, race, and ethnicity in Emergency Department (ED) triage, considering various factors. The focus was assessing variances in Emergency Severity Index (ESI) assignment concerning patient sex and race/ethnicity while adjusting for age, clinical indicators, and ED operational parameters.

A retrospective analysis was conducted across multiple sites, encompassing adult patients visiting high-volume EDs from January 2019 to February 2020. Data were collected from three distinct EDs (academic, metropolitan, and rural communities) affiliated with a primary healthcare system in the Southeastern United States. The study categorized ESI levels into three groups: 1–2 (highest acuity), 3, and 4–5 (lowest acuity). Multinomial logistic regression was employed to compare ESI categories across different patient demographics (with White males as the reference) while adjusting for patient age, insurance status, mode of ED arrival, chief complaint category, comorbidity score, time of day, day of the week, and average ED wait time.

A total of 186,840 eligible ED visits were identified, distributed among the academic ED (56,417 visits), metropolitan community ED (69,698 visits), and rural community ED (60,725 visits). Patient demographics varied across EDs, particularly regarding age, race/ethnicity, and insurance coverage. ESI 3 was predominantly assigned to patients in the academic and metropolitan community EDs (61% and 62%, respectively), whereas only 47% received ESI 3 in the rural community ED. Adjusted analyses indicated that White females were less likely than White males to be assigned ESI 1–2, although both groups showed similar tendencies in ESI 4–5 assignment. Across all EDs, non-White and Hispanic females were generally less likely to receive ESI 1–2. However, interactions between ED wait time and race/ethnicity sex were not statistically significant.

The retrospective examination of adult ED patients identified disparities in ESI assignment based on sex and race/ethnicity, even after adjusting for various factors. The inequities persisted across diverse ED settings, emphasizing the importance of continued research to address disparities in ED triage practices and their impact on patient outcomes.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006137