Triage gap? Analysis of admission rates, service utilisation and mortality for First Nations patients compared to non-First Nations patients, stratified by ED triage category

Background: First Nations patients often experience poorer health outcomes than non-First Nations patients. Despite emergency triage primarily focusing on severity, implying comparable outcomes for patients in the same triage group regardless of demographics, the precision of triage for First-Nations Australians may be undermined by multiple factors, although research in this area is scarce. 

Objective: To compare admission rates, service utilisation and mortality for First Nations and non-First Nations patients, based on their triage categories. 

Methods: This retrospective cohort study utilised data for all adults presenting between January 2016 and May 2021, to Alice Springs Hospital; totalling 175 199 presentations from 39 882 individual patients. Data were analysed for differences between First Nations and non-First nations patients for outcomes including 30-day mortality, admission to hospital and admission to ICU. 

Results: First Nations patients had significantly higher admission than non-First Nations patients across all triage categories (P < 0.001). First Nations patients in categories 3 and 4 had a significantly higher 30-day mortality (P = 0.039, P = 0.045, respectively). First Nations patients in categories 2 and 3 were significantly more likely to be admitted to ICU (P < 0.001). 

Conclusion: First Nations patients appear to have worse outcomes than non-First Nations patients in the same triage category. Socio-economic factors and high discharge against advice rates from wards may explain the significantly higher admission rate. Under-recognition of serious illness at triage could be attributed to communication issues or a ‘well bias’. The results raise many questions and further investigation is required.