Date of Award

1-1-2013

Document Type

Open Access Thesis

Department

Epidemiology and Biostatistics

Sub-Department

Epidemiology

First Advisor

Kellee White

Abstract

Purpose

This study seeks to identify any racial differences present in assigned triage scores, hospitalization status and discharge medications in a rural hospital likely experiencing a surge after a mass casualty incident involving chlorine gas as a result of a train derailment. Differences were examined between Non-Hispanic White and African American adults who were moderately ill and who presented to the emergency department of the closest hospital to the accident site within 24 hours of the incident.

Methods

Non-Hispanic White and African American adults who presented to the emergency department of the closest hospital to the accident site and who complained of chlorine exposure symptoms were included in this descriptive epidemiological study (n=25). Data used was obtained from medical records, utilizing a standardized medical abstraction form. Toxidrome, a compilation of five symptoms specific to chlorine exposure: eye irritation or pain, ear, nose, and throat irritation or pain, cough/wheezing and/or nausea/vomiting documented in the emergency room, was used as a proxy variable for exposure to chlorine gas. Triage score is defined by classifying patients as urgent or non-urgent based on the Simple Triage Rapid Treatment (START) algorithm. Hospitalization status is defined by a coding system created by the Center for Disease

Control (CDC) and South Carolina Department of Health and Environmental Control (SC DHEC) to evaluate the severity of patients' symptoms. Patients were assigned to a hospitalization status group based on this coding system; hospitalized or not hospitalized. Both groups consisted of patients with similar severity symptoms. Discharge medications are defined by the prescribed biologic agents given to each patient upon discharge. Patients were grouped in oral medication or non-oral medication categories. Frequency distributions were calculated for all categorical variables and mean age was calculated for the only continuous variable. All categorical variables were assessed with Chi square or Fishers exact test to determine if racial differences were present in assigned triage scores, hospitalization status, and discharge medications received. Age, the only continuous variable, was assessed with a t-test.

Results

The data suggests that all victims sustained equal effects caused by exposure to chlorine gas (p= 0.283) and that there was no significant difference between demographic characteristics: age, sex, smoking status, and pre-existing pulmonary disease. There was no statistically significant difference between Non-Hispanic Whites and African Americans in discharge medications (p=0.131). The data suggests a significant difference in hospitalization status (p=0.024) by race, where 100% of Non-Hispanic Whites and 62.5% of African Americans were hospitalized. For patients presenting with similar injury severity, a statistically significant difference was observed between Non-Hispanic Whites and African Americans (p=0.027). The percentage of Non-Hispanic Whites (82.4%) was higher than that of African Americans (50.0%) who were given an urgent triage classification.

Conclusion

The present work suggests a difference in triage scores assigned and hospitalization status between Non-Hispanic White and African American adults, who sought treatment at the closest hospital to the accident site during a mass casualty incident. The differences observed may be attributed to non-clinical factors influencing triage decisions and care provided. The implications of differential care based on race are a critically important public health concern. Further research should is needed to investigate why there are racial differences in hospitalization status and triage score assignment for equally exposed patients with similar severity of injuries.

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