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Applying crisis standards of care to critically ill patients during the COVID-19 pandemic: Does race/ethnicity affect triage scoring?
- Source :
-
Journal of the American College of Emergency Physicians open [J Am Coll Emerg Physicians Open] 2021 Jul 12; Vol. 2 (4), pp. e12502. Date of Electronic Publication: 2021 Jul 12 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Objective: Given the variability in crisis standards of care (CSC) guidelines during the COVID-19 pandemic, we investigated the racial and ethnic differences in prioritization between 3 different CSC triage policies (New York, Massachusetts, USA), as well as a first come, first served (FCFS) approach, using a single patient population.<br />Methods: We performed a retrospective cohort study of patients with intensive care unit (ICU) needs at a tertiary hospital on its peak COVID-19 ICU census day. We used medical record data to calculate a CSC score under 3 criteria: New York, Massachusetts with full comorbidity list (Massachusetts1), and MA with a modified comorbidity list (Massachusetts2). The CSC scores, as well as FCFS, determined which patients were eligible to receive critical care under 2 scarcity scenarios: 50 versus 100 ICU bed capacity. We assessed the association between race/ethnicity and eligibility for critical care with logistic regression.<br />Results: Of 211 patients, 139 (66%) were male, 95 (45%) were Hispanic, 23 (11%) were non-Hispanic Black, and 69 (33%) were non-Hispanic White. Hispanic patients had the fewest comorbidities. Assuming a 50 ICU bed capacity, Hispanic patients had significantly higher odds of receiving critical care services across all CSC guidelines, except FCFS. However, assuming a 100 ICU bed capacity, Hispanic patients had greater odds of receiving critical care services under only the Massachusetts2 guidelines (odds ratio, 2.05; 95% CI, 1.09 to 3.85).<br />Conclusion: Varying CSC guidelines differentially affect racial and ethnic minority groups with regard to risk stratification. The equity implications of CSC guidelines require thorough investigation before CSC guidelines are implemented.<br />Competing Interests: None.<br /> (© 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
Details
- Language :
- English
- ISSN :
- 2688-1152
- Volume :
- 2
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Emergency Physicians open
- Publication Type :
- Academic Journal
- Accession number :
- 34278377
- Full Text :
- https://doi.org/10.1002/emp2.12502