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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
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.
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“suggesting that in Black sepsis patients are more likely to be assessed as being more pathologically advanced than they are (Miller et al., 2021; Roy et al., 2021; Tolchin et al., 2021).”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Roy et al., 2021
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“High creatinine levels when incorporated into SOFA scores, however, often result in US Black patients having a higher SOFA score than White patients, but not higher in‐hospital mortality”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Roy et al., 2021
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Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms
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Hospitalization and mortality among Black patients and White patients with Covid-19.
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“Despite this, our findings that Black COVID-19 patients had higher SOFA scores align with the overall literature that suggests a higher burden of morbidity of COVID-19 in Black patients [2, 26, 30, 31, 33].”
BackgroundResultRacial and Ethnic Disparities in Population-Level Covid-19 Mortality
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Cited by
Sorted by citations
On race, human variation, and who gets and dies of sepsis
Brinkworth, J. F., & Shaw, J. G. (2022) · American Journal of Biological Anthropology · doi:10.1002/ajpa.24527 · Cited by 9
Metadata
- Authors
- Roy, S., Showstark, M., Tolchin, B., Kashyap, N., Bonito, J., Salazar, M. C., Herbst, J. L., Nash, K. A., Nguemeni Tiako, M. J., Jubanyik, K., Kim, N., Galusha, D., Wang, K. H., & Oladele, C.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-09-16
- Volume
- 16
- Issue
- 9
- Pages
- e0256763
- ISSN
- 1932-6203
- PMC
- PMC8445412
- Cited by
- 19
- References
- 6
- Language
- en
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