Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring?

• Published in: Journal of the American College of Emergency Physicians Open 2021-08, Vol.2 (4), p.e12502-n/a, Article e12502
• Main 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
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Chronic illnesses; Chronic obstructive pulmonary disease; Coronaviruses; COVID-19; crisis standards of care; Critical care; Diabetes; Egalitarianism; emergency department; Ethnicity; Health care access; health disparities; Health Policy; Hispanic Americans; Hospitals; Hypertension; Intubation; Kidney diseases; Medical prognosis; Neuromuscular diseases; Original Research; Oxygen saturation; Patients; Primary care; Principles; Race; Standard of care; Ventilators
• ISSN: 2688-1152; 2688-1152
• DOI: 10.1002/emp2.12502

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.