Undertriage for Children With Caregivers Preferring Languages Other Than English

Authors

Christina R. Rojas, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
James M. Chamberlain, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
Joanna S. Cohen, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
Gia M. Badolato, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
Lawrence J. Cook, University of Utah Department of Pediatrics, Salt Lake City, Utah.
Monika K. Goyal, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
Deena Berkowitz, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

5-16-2023

Journal

Pediatrics

DOI

10.1542/peds.2022-059386

Abstract

OBJECTIVES: Undertriage, the underestimation of acuity, can result in delayed care and potential morbidity in the emergency department (ED). Although inequities in ED care based on language preference have been noted, little is known about its association with undertriage. We evaluated for differences in undertriage based on caregiver language preference. METHODS: This was a retrospective cross-sectional study of patients aged younger than 21 years, triaged as Emergency Severity Index (ESI) level 4 or 5 (nonurgent), to the pediatric ED from January 1, 2019, through January 31, 2021. Indicators of undertriage were defined as hospital admission, significant ED resource use, or return visits with admission. We used logistic regression with generalized estimating equations to measure the association of preferred language with undertriage. RESULTS: Of 114 266 ED visits included in the study, 22 525 (19.8%) represented patients with caregivers preferring languages other than English. These children were more likely to experience undertriage compared with those with caregivers preferring English (3.7% [English] versus 4.6% [Spanish] versus 5.9% [other languages]; Spanish versus English: odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4] and other languages versus English: OR, 1.6; 95% CI, 1.2-2.2). Differences remained after adjusting for sex, insurance, mode of arrival, and clustering by triage nurse (Spanish versus English: adjusted OR, 1.3; 95% CI, 1.3-1.5) and other languages versus English: adjusted OR, 1.6; 95% CI, 1.2-2.2). CONCLUSIONS: Children accompanied by caregivers preferring languages other than English are more likely to be undertriaged in the pediatric ED. Efforts to improve the triage process are needed to promote equitable care for this population.

APA Citation

Rojas, Christina R.; Chamberlain, James M.; Cohen, Joanna S.; Badolato, Gia M.; Cook, Lawrence J.; Goyal, Monika K.; and Berkowitz, Deena, "Undertriage for Children With Caregivers Preferring Languages Other Than English" (2023). GW Authored Works. Paper 2902.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2902

Department

Pediatrics