Risk Factors for Undertriage of Children Presenting to a Pediatric Emergency Department With Abdominal Pain

OBJECTIVES: To identify demographic and clinical risk factors associated with undertriage of pediatric patients presenting to the emergency department with abdominal pain. METHODS: This retrospective cross-sectional study included pediatric patients who presented to the pediatric ED at an academic urban hospital between January 1, 2023, and December 31, 2023, with a chief complaint of abdominal pain and were triaged as Emergency Severity Index level 4. Undertriage was defined as a triage level 4 assignment followed by hospital admission or use of more than 1 resource category. Demographic and clinical data, including age, sex, race, ethnicity, insurance type, interpreter use, disposition, and resource utilization, were extracted from the electronic health record. Multivariable logistic regression was used to assess the association between interpreter use and undertriage, adjusting for potential confounders. RESULTS: A total of 603 patients met the inclusion criteria, of which 198 (32.8%) were undertriaged. Undertriage was more likely among patients who required an interpreter and were 13 years or older. Undertriage was less likely among those identifying as Black or Hispanic. Presentations during overnight hours were also associated with lower odds of undertriage. No significant seasonal variation was observed. Among undertriaged patients, most patients underwent both laboratory testing (93.9%) and imaging (80.3%). CONCLUSIONS: Nearly one-third of pediatric patients with abdominal pain triaged as level 4 were undertriaged. Patients 13 and older were more likely to be undertriaged compared with those aged 1 to 12. Interpreter use was associated with higher odds of undertriage, while Hispanic ethnicity and Black race were associated with lower odds of undertriage. These findings highlight the importance of addressing language-related barriers and other factors that influence equitable triage in the pediatric emergency department.