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

Jossie Carreras‐Tartak¹  Carlos A. Camargo Jr¹  Margaret Samuels‐Kalow¹  Wendy Macias‐Konstantopoulos¹  Rebecca E. Cash¹  Giovanni Rodriguez¹  Gia Ciccolo¹  Melanie F. Molina¹  Keizra Mecklai²  Okechi Boms²  David Velasquez²  Jordan Petersen²  Noelle Castilla‐Ojo² 

[1] Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA;Harvard Medical School Boston Massachusetts USA;

关键词: COVID‐19;    crisis standards of care;    emergency department;    health disparities;   

DOI  :  10.1002/emp2.12502

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown