Patient Demographic Factors in Emergency Department Triage Acuity and Care Timeliness Among Adults With Chest Pain

Emergency department (ED) triage acuity, commonly assigned using the Emergency Severity Index (ESI), is critical for the timely evaluation of patients presenting with chest pain (CP). Differences in ESI score may impact time to provider assessment and diagnostic testing. Prior studies suggest that social and demographic factors may influence triage decisions, though evidence remains inconsistent. The objective of this study is to evaluate associations between patient demographic factors and ESI assignment among adults presenting with chest pain and examine the relationship between triage acuity and care timeliness.

We conducted a retrospective cohort study of adults aged 18–64 presenting with CP to a high-volume, academic, tertiary ED. The primary outcome was high-acuity triage assignment (ESI 2 versus ESI 3). Multivariable logistic regression was used to estimate the odds of ESI 2 score, adjusting for age, race, sex, body mass index, vital signs, and selected social determinants of health. Secondary outcomes included time to provider evaluation.

A total of 5,788 patients presented to the ED with a chief complaint of CP. Increasing age and elevated heart rate were significantly associated with higher odds of ESI 2 assignment. Black patients had significantly lower odds of ESI 2 assignment compared with White patients (OR 0.91, 95% CI 0.85–0.96), and female patients had lower odds compared with male patients (OR 0.88, 95% CI 0.78–0.99). The ESI 2 score was associated with a significantly shorter time to provider evaluation.

Black race and female sex were associated with a lower likelihood of ESI 2 assignment among adults presenting with CP. These findings highlight differences in triage acuity and early care measures that may reflect multiple patient and system-level factors. Further studies are needed to characterize the drivers of these differences and their implications for emergency cardiovascular care.