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Study: Children with non-English-speaking caregivers more likely to be under-triaged in ED

May 16, 2023

Emergency department (ED) staff are more likely to underestimate the severity of children’s condition when their caregivers speak a language other than English, a new study found.

“This has the potential to lead to significant additional downstream safety concerns, because the underestimation of a patient’s severity of illness could lead to inappropriate or delayed care,” authors wrote in the study “Under-triage for Children with Caregivers Preferring Languages Other than English,” (Rojas CR, et al. Pediatrics. May 16, 2023).

Researchers from Children’s National Hospital in Washington, D.C., analyzed data on children under 21 years visiting two EDs from January 2019 through January 2021.

There were 114,266 visits in which children were given a nonurgent classification. Data showed 4% of the visits were “under-triaged,” meaning the patient ultimately needed significant ED resources, hospital admission or returned and was admitted to the hospital within 14 days.

The most common conditions to be under-triaged involved the skin/soft tissue, gastrointestinal system, upper respiratory system, viral infections and asthma.

About 3.7% of patients whose caregiver preferred English were under-triaged compared to 4.6% of those whose caregiver preferred Spanish and 5.9% whose caregiver preferred another language, according to the study.

Increased odds of requiring hospital admission or significant ED resources were seen for families speaking Spanish and other non-English languages. Only the Spanish-speaking families had increased odds of a return visit with hospital admission.

“It is possible that interpreters are underused or inappropriately used in triage, especially when considering the environment, which is fast-paced and relies on brief interactions to quickly determine acuity,” authors wrote.

They also suggested bias among health care providers may have played a role.

Authors noted the study was conducted in just two EDs and called for broadening future research. They also called on EDs to ensure interpretation is easily available and to use creative solutions like a mobile application that could help with interpretation.

“Subsequent work will focus on evaluating for differences in downstream effects of under-triage, including adverse events, as well as engaging in quality improvement efforts to mitigate disparities in under-triage based on preferred language,” they wrote.





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