title: Racial Differences in Pediatric Emergency Department Triage Scores.
abstract: BACKGROUND
  Racial disparities are frequently reported in emergency department (ED) care.
  
  
  OBJECTIVE
  To examine racial differences in triage scores of pediatric ED patients. We hypothesized that racial differences existed but could be explained after adjusting for sociodemographic and clinical factors.
  
  
  METHODS
  We examined all visits to two urban, pediatric EDs between August 2009 and March 2010. Demographic and clinical data were electronically extracted from the medical record. We used logistic regression to analyze racial differences in triage scores, controlling for possible covariates.
  
  
  RESULTS
  There were 54,505 ED visits during the study period, with 7216 (13.2%) resulting in hospital admission. White patients accounted for 36.4% of visits, African Americans 28.5%, Hispanics 18.0%, Asians 4.1%, and American Indians 1.8%. After adjusting for potential confounders, African American (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.69-2.12), Hispanic (aOR 1.77, 95% CI 1.55-2.02), and American Indian (aOR 2.57, 95% CI 1.80-3.66) patients received lower-acuity triage scores than Whites. In three out of four subgroup analyses based on presenting complaints (breathing difficulty, abdominal pain, fever), African Americans and Hispanics had higher odds of receiving low-acuity triage scores. No racial differences were detected for patients with presenting complaints of laceration/head injury/arm injury. However, among patients admitted to the hospital, African Americans (aOR 1.47, 95% CI 1.13-1.90) and Hispanics (aOR 1.71, CI 1.22-2.39) received lower-acuity triage scores than Whites.
  
  
  CONCLUSIONS
  After adjusting for available sociodemographic and clinical covariates, African American, Hispanic, and American Indian patients received lower-acuity triage scores than Whites.
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Zook
authors.affiliation: Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Andrew
authors.initials: A
authors.lastname: Flood
authors.affiliation: Department of Quality and Safety, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Brian
authors.initials: B
authors.lastname: Harmon
authors.affiliation: Center for Health Outcomes and Prevention Research, Sanford Research, Sioux Falls, South Dakota; Department of Pediatrics, Sanford School of Medicine of the University of South Dakota, Sioux Falls, South Dakota.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Puumala
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Department of Quality and Safety, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
mesh_terms: D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000208:ethnology / Q000706:statistics & numerical data; D016015:Logistic Models; D010372:Pediatrics / Q000706:statistics & numerical data*; D063505:Racism / Q000208:ethnology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data
keywords: health disparities; pediatrics; race; triage