Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring?. Issue 4 (12th July 2021)

• Record Type: Journal Article
• Authors: Molina, Melanie F.; Cash, Rebecca E.; Carreras‐Tartak, Jossie; Ciccolo, Gia; Petersen, Jordan; Mecklai, Keizra; Rodriguez, Giovanni; Castilla‐Ojo, Noelle; Boms, Okechi; Velasquez, David; Macias‐Konstantopoulos, Wendy; Camargo, Carlos A.; Samuels‐Kalow, Margaret
• Is Part Of: JACEP open. Volume 2:Issue 4(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-07-12
• Subjects: COVID‐19 -- crisis standards of care -- emergency department -- health disparities; Medical emergencies -- Periodicals; 616.025
• DOI: 10.1002/emp2.12502
• Languages: English
• ISSNs: 0361-1124

Abstract

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.