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Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring?
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) approac...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275820/ https://www.ncbi.nlm.nih.gov/pubmed/34278377 http://dx.doi.org/10.1002/emp2.12502 |
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author | 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 |
author_facet | 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 |
author_sort | Molina, Melanie F. |
collection | PubMed |
description | 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 | Online Article Text |
id | pubmed-8275820 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82758202021-07-15 Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? 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 J Am Coll Emerg Physicians Open Health Policy 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. John Wiley and Sons Inc. 2021-07-12 /pmc/articles/PMC8275820/ /pubmed/34278377 http://dx.doi.org/10.1002/emp2.12502 Text en © 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Health Policy 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 Applying crisis standards of care to critically ill patients during the COVID‐19 pandemic: Does race/ethnicity affect triage scoring? |
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 | Health Policy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275820/ https://www.ncbi.nlm.nih.gov/pubmed/34278377 http://dx.doi.org/10.1002/emp2.12502 |
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