Preferred language and diagnostic errors in the pediatric emergency department

Jeremiah T. Lowe; Jan Leonard; Fidelity Dominguez; Kaitlin Widmer; Sara J. Deakyne Davies; Alexandria J. Wiersma; Marcela Mendenhall; Joseph A. Grubenhoff

doi:10.1515/dx-2023-0079

Article

Preferred language and diagnostic errors in the pediatric emergency department

Jeremiah T. Lowe , Jan Leonard , Fidelity Dominguez , Kaitlin Widmer , Sara J. Deakyne Davies , Alexandria J. Wiersma , Marcela Mendenhall and Joseph A. Grubenhoff

Published/Copyright: October 6, 2023

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From the journal Diagnosis Volume 11 Issue 1

Abstract

Objectives

To investigate the relationship between language and diagnostic errors (DxE) in the pediatric emergency department (ED).

Methods

Electronic trigger identified ED encounters resulting in unplanned hospital admission that occurred within 10 days of an index visit from January 2018 through February 2022. Manual screening of each triggered encounter identified cases where the index visit diagnosis and hospitalization discharge diagnosis differed, and these were screened in for review using the Revised Safer Dx instrument to determine if a diagnostic error (DxE) occurred. Non-English primary language (NEPL) and English-proficient (EP) groups were established based on caregiver language. The primary outcome was the proportion of DxE each group. Data were analyzed using univariate analysis and multivariable logistic regression to identify independent predictors of DxE.

Results

Electronic trigger identified 3,551 patients, of which 806 (22.7 %) screened in for Safer Dx review. 172 (21.3 %) experienced DxE. The proportion of DxE was similar between EP and NEPL groups (21.5 vs. 21.7 %; p=0.97). Age≥12 years and fewer prior admissions in the preceding 6 months predicted higher odds of DxE. NEPL did not predict higher odds of DxE.

Conclusions

NEPL was not associated with increased odds DxE resulting in unplanned admission.

Keywords: language; diagnostic error; emergency department

Corresponding author: Jeremiah T. Lowe, MD, MSc, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 158, Aurora, CO 80045, USA, E-mail: jeremiah.lowe@cuanschutz.edu

Research ethics: The local Institutional Review Board deemed the study exempt from review.
Informed consent: Not applicable.
Author contributions: Dr. Jeremiah Lowe conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. Jan Leonard performed all data analysis and critically reviewed and revised the manuscript. Fidelity Dominguez and Drs. Kaitlin Widmer, Alexandria Wiersma, and Marcela Mendenhall collected data and critically reviewed and revised the manuscript. Sara Deakyne Davies developed the electronic trigger, helped design the research database, and critically reviewed the manuscript. Dr. Joseph Grubenhoff conceptualized and designed the study, developed the electronic trigger, developed data collection instruments, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2023-06-29

Accepted: 2023-09-04

Published Online: 2023-10-06

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Articles in the same Issue

https://doi.org/10.1515/dx-2023-0079

Keywords for this article

language; diagnostic error; emergency department