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The potential impact of triage protocols on racial disparities in clinical outcomes among COVID-positive patients in a large academic healthcare system.
Roy, Shireen; Showstark, Mary; Tolchin, Benjamin; Kashyap, Nitu; Bonito, Jennifer; Salazar, Michelle C; Herbst, Jennifer L; Nash, Katherine A; Nguemeni Tiako, Max Jordan; Jubanyik, Karen; Kim, Nancy; Galusha, Deron; Wang, Karen H; Oladele, Carol.
  • Roy S; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
  • Showstark M; Yale School of Medicine Physician Assistant Online Program, Yale Institute of Global Health, National Disaster Medical System, New Haven, CT, United States of America.
  • Tolchin B; Department of Neurology, Yale School of Medicine, Epilepsy Center of Excellence, VA Connecticut Healthcare System, Yale New Haven Health, New Haven, CT, United States of America.
  • Kashyap N; Yale New Haven Health, New Haven, CT, United States of America.
  • Bonito J; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America.
  • Salazar MC; Department of Surgery, Yale School of Medicine, National Clinician Scholars Program, New Haven, CT, United States of America.
  • Herbst JL; Quinnipiac University School of Law, Frank H. Netter, MD, School of Medicine at Quinnipiac University, North Haven, CT, United States of America.
  • Nash KA; Department of Pediatrics, Yale School of Medicine, National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, United States of America.
  • Nguemeni Tiako MJ; Yale School of Medicine, New Haven, CT, United States of America.
  • Jubanyik K; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America.
  • Kim N; Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America.
  • Galusha D; Yale School of Medicine, New Haven, CT, United States of America.
  • Wang KH; Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America.
  • Oladele C; Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America.
PLoS One ; 16(9): e0256763, 2021.
Article in English | MEDLINE | ID: covidwho-1416875
ABSTRACT

BACKGROUND:

The COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes.

METHODS:

We analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics.

RESULTS:

Our final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races.

CONCLUSION:

While Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Triage / Delivery of Health Care / Healthcare Disparities / Organ Dysfunction Scores / COVID-19 / Hospitals, University Subject: Triage / Delivery of Health Care / Healthcare Disparities / Organ Dysfunction Scores / COVID-19 / Hospitals, University Type of study: Determinantes_sociais_saude / Equity and inequality / Clinical Practice Guide / Observational study / Prognostic study / Risk factors Language: English Journal: PLoS One Clinical aspect: Etiology / Prediction / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Triage / Delivery of Health Care / Healthcare Disparities / Organ Dysfunction Scores / COVID-19 / Hospitals, University Subject: Triage / Delivery of Health Care / Healthcare Disparities / Organ Dysfunction Scores / COVID-19 / Hospitals, University Type of study: Determinantes_sociais_saude / Equity and inequality / Clinical Practice Guide / Observational study / Prognostic study / Risk factors Language: English Journal: PLoS One Clinical aspect: Etiology / Prediction / Prognosis Year: 2021
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