Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring?
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)...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12502 |
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| author | Melanie F. Molina Rebecca E. Cash Jossie Carreras‐Tartak Gia Ciccolo Jordan Petersen Keizra Mecklai Giovanni Rodriguez Noelle Castilla‐Ojo Okechi Boms David Velasquez Wendy Macias‐Konstantopoulos Carlos A. Camargo Jr Margaret Samuels‐Kalow |
| author_facet | Melanie F. Molina Rebecca E. Cash Jossie Carreras‐Tartak Gia Ciccolo Jordan Petersen Keizra Mecklai Giovanni Rodriguez Noelle Castilla‐Ojo Okechi Boms David Velasquez Wendy Macias‐Konstantopoulos Carlos A. Camargo Jr Margaret Samuels‐Kalow |
| author_sort | Melanie F. Molina |
| collection | DOAJ |
| description | 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. 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. 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). 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. |
| format | Article |
| id | doaj-art-cc97e60cf47442dfbc6e7e221e8720c4 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-cc97e60cf47442dfbc6e7e221e8720c42025-08-20T02:19:58ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-08-0124n/an/a10.1002/emp2.12502Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring?Melanie F. Molina0Rebecca E. Cash1Jossie Carreras‐Tartak2Gia Ciccolo3Jordan Petersen4Keizra Mecklai5Giovanni Rodriguez6Noelle Castilla‐Ojo7Okechi Boms8David Velasquez9Wendy Macias‐Konstantopoulos10Carlos A. Camargo Jr11Margaret Samuels‐Kalow12Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USAHarvard Medical School Boston Massachusetts USAHarvard Medical School Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USAHarvard Medical School Boston Massachusetts USAHarvard Medical School Boston Massachusetts USAHarvard Medical School Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USAAbstract 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. 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. 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). 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.https://doi.org/10.1002/emp2.12502COVID‐19crisis standards of careemergency departmenthealth disparities |
| spellingShingle | Melanie F. Molina Rebecca E. Cash Jossie Carreras‐Tartak Gia Ciccolo Jordan Petersen Keizra Mecklai Giovanni Rodriguez Noelle Castilla‐Ojo Okechi Boms David Velasquez Wendy Macias‐Konstantopoulos Carlos A. Camargo Jr Margaret Samuels‐Kalow Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? Journal of the American College of Emergency Physicians Open COVID‐19 crisis standards of care emergency department health disparities |
| title | Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? |
| title_full | Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? |
| title_fullStr | Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? |
| title_full_unstemmed | Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? |
| title_short | Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? |
| title_sort | applying crisis standards of care to critically ill patients during the covid 19 pandemic does race ethnicity affect triage scoring |
| topic | COVID‐19 crisis standards of care emergency department health disparities |
| url | https://doi.org/10.1002/emp2.12502 |
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