Triage disparities widen in lower-risk emergency visits, multicenter analysis finds

A multicenter analysis of 1.35 million emergency-department encounters found that Hispanic patients were less likely than non-Hispanic White patients to receive an emergent triage designation at all four participating U.S. hospitals, with the largest differences occurring in visits independently scored as lower risk. Non-Hispanic Black patients also had lower odds of emergent triage at two sites, according to the study in Nature Communications.

Researchers examined encounters at four U.S. emergency departments that all used the Emergency Severity Index, or ESI, to triage patients. They independently classified visits as emergent, level 2, or urgent, level 3, by computationally applying the protocol’s criteria, then compared these assessments with acuity levels assigned by nurses. The analysis matched encounters on clinical presentation and hospital context, allowing comparisons within clinically similar cases treated at the same institution rather than across unrelated hospitals or conditions.

After matching, Hispanic patients had lower odds of emergent triage than non-Hispanic White patients at every site. The odds ratios ranged from 0.75 (95% confidence interval [CI], 0.72–0.78) to 0.90 (0.86–0.94). The pattern was stronger among visits the independent algorithm scored as lower risk: Hispanic-to-non-Hispanic-White odds ratios ranged from 0.73 (0.69–0.77) to 0.88 (0.83–0.94). In higher-risk encounters, the disparities attenuated, with odds ratios of 0.83 (0.79–0.89) to 0.95 (0.90–1.00).

Non-Hispanic Black patients were less likely than non-Hispanic White patients to be triaged as emergent at two of the four sites, with odds ratios of 0.73 (95% CI, 0.71–0.74) and 0.89 (0.86–0.92). The concentration of differences among lower-risk visits was consistent with a disparate “benefit-of-the-doubt” pattern of clinical discretion: the greatest gaps appeared when the independently applied criteria did not clearly require an emergent designation. The results show an association in the analyzed encounters, not proof that ethnoracial identity caused any individual triage decision.

The authors proposed that standardized decision support may help reduce these disparities. They also estimated that implementing such support could increase emergency-department length of stay by 1.0% to 3.8% across the four sites in a worst-case scenario. This was a modeled potential effect rather than an observed intervention outcome, and the supplied study report does not establish whether decision support eliminated or reduced disparities in practice. Overall, the analysis identifies a concentration of triage differences in lower-risk cases, where independently assessed severity left more room for clinical judgment and the odds of an emergent designation diverged most clearly between Hispanic and non-Hispanic White patients.

Subject of Research: Ethnoracial differences in emergency-department triage across four U.S. hospitals

Article Title: Ethnoracial disparities in emergency department triage are more pronounced in lower-risk visits: a multicenter study

Article References: Romero Milà, B., Coggan, H., Fine, A. M., Barak-Corren, Y., Reis, B. Y., Aysola, J., Chaudhari, P. P., & La Cava, W. G. (2026). Ethnoracial disparities in emergency department triage are more pronounced in lower-risk visits: a multicenter study. Nature Communications. https://doi.org/10.1038/s41467-026-78526-5

Image Credits: AI Generated

DOI: 10.1038/s41467-026-78526-5

Keywords: emergency medicine, triage, health disparities, Emergency Severity Index, Hispanic patients, Black patients, clinical discretion, decision support, length of stay, multicenter analysis, Ethnoracial, disparities