Accuracy in identification of pre-eclampsia patients at emergency department triage: A quantitative descriptive study

Introduction: To describe the accuracy of triage decision-making in a sample of US emergency departments regarding the identification of preeclampsia in both pregnant and postpartum patients. Methods: A quantitative correlative retrospective approach using a large data set to verify the impact of accurate identification of the high-risk preeclamptic patient at triage. Data were extracted from a dataset of de-identified ED records. All female-identified patients presenting to the study sites from January 1, 2022-September 30, 2023, were included. Accurate triage of patients was modeled using logistic regression to identify significance and strength of associations between ESI classification and patient disposition outcomes in high-risk patients with the specific emergency department diagnosis of preeclampsia. Results: The final sample included over 1.3 million patients whose record contained an ICD-10 code describing suspected perinatal preeclampsia in 25 sites across four U.S. states. The percentage of high-risk perinatal presentations at triage ranged from 17.7% to 23.3% across sites; the percentage of those patients with a final (confirmed) diagnosis of preeclampsia comprised 881 patients of 243,872 high-risk presentations. Of the 881 patients with preeclampsia, 80.1% (711) were under triaged. Women in the preeclampsia cohort were 66% more likely to be in a maternal care desert and 59% were Hispanic or non-white. Conclusions: While high risk pregnancy and postpartum presentations are 18.5% of the obstetric population presenting to emergency departments, they are under triaged 50% of the time; when a very high risk, low volume presentation such as preeclampsia is present, those patients are under triaged 80% of the time. Given the documented inadequacy of education related to obstetric emergencies, and growing maternal care deserts, these findings suggest a concerning situation for patients seeking pregnancy-related care in emergency departments.