P2.175: Risk factors for Under-triage of Children presenting to the ED with Abdominal Pain

Background: Under triage, or the underestimation of illness severity during patient triaging, leads to inappropriate allocation of resources in the emergency department, delays in care, and misdiagnosis. The goal of this study was to determine risk factors for under triage for pediatric patients presenting to the emergency department specifically with abdominal pain.

Methods: This was a retrospective cross-sectional study of patients younger than 18 years of age, triaged as Emergency Severity Index level 4 (nonurgent) with a chief complaint of abdominal pain. All patients presenting to the pediatric ED at Johns Hopkins Children’s Center from January 1st, 2023 to December 31st, 2023 with a chief complaint of abdominal pain were included in the analysis. Under triage defined by encounters in which the patient was triaged as level 4 and required hospital admission or more than one resource including labs, radiographic imaging, electrocardiography, intravenous infusions, nebulized medication, procedures, or subspecialty consultations. Demographic data (including sex, age, race, ethnicity, interpreter use, and insurance type), ED disposition, and resource use was collected from the electronic health record. We performed descriptive statistics, logistic, and multivariable logistic regression to determine the association of under triage with sex, age, race, ethnicity, interpreter use, and insurance type. Regression models were fit to derive odds ratios and adjusted odds ratios with 95% confidence intervals.

Results: Of 603 ED visits included in the study, 222 (36.82%) visits had male patients whereas 381 (63.18%) visits had female patients. Female patients were more likely to experience under triage compared to male patients (OR 1.76; 95% CI, 1.22 to 2.54). No other demographic factors including age, race, ethnicity, interpreter use, and insurance type were associated with under triage for abdominal pain. (Adjusted analysis pending at the time of submission.

Conclusion: Females are at an increased risk of being under triaged when presenting to the pediatric ED with abdominal pain. Implementing standardized, objective triage protocols may help guard against gender bias and ensure that all patients receive equitable assessments and timely care.