Study of 15 U.S. Hospitals Reveals Pediatric Mental Health Triage Inaccurate in Two-Thirds of Emergency Visits

Lurie Children's Hospital study finds widespread inaccuracies and racial disparities in pediatric mental health triage within U.S. emergency departments.

By: AXL Media

Published: Mar 25, 2026, 6:21 AM EDT

Source: Information for this report was sourced from Ann & Robert H. Lurie Children's Hospital of Chicago

The Critical Role of Urgency Assessment in Pediatric Care

In the high-pressure environment of emergency medicine, the triage process serves as the primary mechanism for differentiating patients who require immediate intervention from those who can safely wait. However, new research suggests that this system is faltering when applied to children presenting with mental or behavioral health concerns. A study led by Dr. Jennifer Hoffmann indicates that triage scores for these patients were inaccurate in two-thirds of cases compared to the actual intensity of care provided during the visit. This misalignment poses a potential risk to both patient and staff safety, particularly as emergency departments grapple with an ongoing surge in the youth mental health crisis.

Disparating Outcomes in Severity Scoring

The research utilized the Emergency Severity Index, a standardized triage system implemented in over 90 percent of emergency departments across the United States. Upon analyzing 74,564 visits from children aged 5 to 17, the study found that over-triage occurred in 57 percent of cases, where the assigned severity was higher than the subsequent clinical needs. More concerningly, under-triage—assigning a lower severity score than required—affected approximately one in 12 visits. These inaccuracies suggest that the current tools may not be sufficiently calibrated to capture the nuances of psychiatric urgency in younger populations.

Systemic Inequities and Linguistic Barriers

A significant portion of the study focused on the demographic drivers behind mis-triage, uncovering persistent inequities based on race and language. Under-triage was found to be more likely for children who were Black or Hispanic, as well as for families who identified Spanish as their preferred language. Dr. Hoffmann noted that these discrepancies may be driven by implicit biases or unconscious stereotypes held by clinical staff. Furthermore, a lack of readily accessible interpretation services in emergency settings may prevent families from effectively communicating the true severity of a child’s behavioral or emotional distress.