. 2023 Mar 17;6(3):e233404. doi: 10.1001/jamanetworkopen.2023.3404

Table 3. Multivariate Adjusted Relative Risks of Patient and Visit Characteristics Associated With Undertriage and Overtriage.

Characteristic	Relative risk (95% CI)^a
Characteristic	Undertriage	Overtriage
Demographic
Age, y
18-29	1 [Reference]	1 [Reference]
30-39	0.89 (0.87-0.90)	0.92 (0.92-0.92)
40-49	0.84 (0.83-0.86)	0.83 (0.82-0.84)
50-59	0.84 (0.82-0.85)	0.77 (0.77-0.88)
60-69	0.83 (0.82-0.85)	0.73 (0.72-0.73)
70-79	0.77 (0.76-0.79)	0.70 (0.69-0.71)
≥80	0.66 (0.65-0.68)	0.70 (0.69-0.70)
Women
No	1 [Reference]	1 [Reference]
Yes	0.81 (0.80-0.82)	0.94 (0.95-0.95)
Race and ethnicity
Non-Hispanic White	1 [Reference]	1 [Reference]
Asian	1.01 (0.99-1.02)	0.98 (0.97-0.98)
Black	1.18 (1.17-1.20)	1.05 (1.04-1.05)
Hispanic	1.01 (0.99-1.02)	0.99 (0.98-0.99)
Unknown, missing, or other^b	1.05 (0.99-1.02)	1.01 (1.01-1.02)
Non-English primary language
No	1 [Reference]	1 [Reference]
Yes	0.95 (0.93-0.96)	0.96 (0.95-0.96)
NDI (standardized)
1-SD increase	1.03 (1.02-1.03)	1.01 (1.01-1.01)
NDI is imputed^c
No	1 [Reference]	1 [Reference]
Yes	1.03 (1.02-1.03)	0.98 (0.97-0.99)
Visit measures
Visit during office hours^d
No	1 [Reference]	1 [Reference]
Yes	0.92 (0.91-0.93)	0.93 (0.92-0.93)
Arrived by ambulance
No	1 [Reference]	1 [Reference]
Yes	1.09 (1.08-1.10)	0.68 (0.67-0.68)
Year of visit
2016	1 [Reference]	1 [Reference]
2017	1.06 (1.04-1.07)	0.98 (0.96-0.98)
2018	1.08 (1.07-1.10)	0.96 (0.96-0.96)
2019	1.05 (1.04-1.06)	0.95 (0.95-0.96)
2020	1.07 (1.05-1.08)	0.89 (0.89-0.89)
Non-KPNC health plan member at visit
No	1 [Reference]	1 [Reference]
Yes	1.15 (1.12-1.18)	1.10 (1.09-1.10)
Risk factors^e
Immunosuppression
No	1 [Reference]	1 [Reference]
2019	0.99 (0.05-1.03)	0.90 (0.90-0.91)
Chemotherapy
No	1 [Reference]	1 [Reference]
2020	0.86 (0.84-0.88)	0.90 (0.90-0.91)
Insulin or sulfonylurea use
No	1 [Reference]	1 [Reference]
Yes	1.30 (1.28-1.32)	0.90 (0.90-0.91)
Anticoagulation use
No	1 [Reference]	1 [Reference]
Yes	1.03 (1.01-1.05)	0.90 (0.89-0.90)
COPS2 comorbidity score
Low (<20)	1 [Reference]	1 [Reference]
High (≥65)	1.22 (1.20-1.24)	0.83 (0.83-0.84)
Moderate (20 to <65)	0.94 (0.93-0.95)	0.91 (0.90-0.91)
COPS2 score imputed^f
No	1 [Reference]	1 [Reference]
Yes	1.15 (1.12-1.18)	1.13 (1.13-1.14)
Utilization in prior 30 d
Hospitalized
No	1 [Reference]	1 [Reference]
Yes	1.01 (0.99-1.03)	0.85 (0.84-0.85)
ICU admission
No	1 [Reference]	1 [Reference]
Yes	1.30 (1.30-1.41)	0.96 (0.94-0.97)
ED visit in prior 30 d
No	1 [Reference]	1 [Reference]
Yes	0.86 (0.85-0.87)	1.04 (1.04-1.04)

Abbreviations: COPS2, Comorbidity Point Score, version 2; ED, emergency department; ICU, intensive care unit; KPNC, Kaiser Permanente Northern California; NDI, Neighborhood Deprivation Index.

^{^a}

Relative risks less than 1.00 indicate lower relative risk of undertriage or overtriage; greater than 1.00, higher relative risk of undertriage or overtriage; and 95% CIs that cross 1, no significant change. The model was also adjusted for study facility and triage vital signs (heart rate, blood pressure, respiratory rate, temperature, and pulse oximetry).

^{^b}

Includes American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and more than 1 race.

^{^c}

The missingness rate for NDI was 0.8%.

^{^d}

Office hours were defined as ED arrival times from 9 am to 5 pm, Monday through Friday.

^{^e}

Active treatment with a high-risk medication (chemotherapy, immunosuppressants, anticoagulants, and insulin or sulfonylureas) was defined as a medication dispensed within the 6 months prior to study ED visit.

^{^f}

The missingness rate for COPS2, a longitudinal comorbidity score based on 12 months of patient data,⁴¹ was 18.2%.