Children with SUD or mental health problems may be over or under treated in ED based on age and race

Children presenting with mental or substance use disorder (SUD) in the emergency department (ED) may be overtriaged or undertriaged based on their age and race, according to researchers. Their study, “Overtriage and Undertriage of Children Presenting to the Emergency Department for Behavioral Health,” analyzes a cross section of 74,564 pediatric visits for either mental or substance use symptoms across 15 EDs. The researchers found that 57% were overtriaged and 8% were undertriaged. Younger patients were more likely to be overtriaged, and Hispanic and Black children more likely than White children to be undertriaged. In addition, patients who preferred speaking Spanish to English were more likely to be undertriaged. There is a standard for triage: the Emergency Severity Index. But this system in triaging children with “behavioral health” symptoms is not well studied. Triage involves referring patients to a higher level of care beyond the ED. Overtriage could mean sending a child to specialized or inpatient care when the care is not necessary; undertriage could mean, tragically, the opposite. The study was published March 2 in JAMA Network Open . The lead author is JA Hoffman.