Language Barriers in Care for Low-Risk Febrile Neonates

Abstract

The management of febrile neonates has evolved as clinical evidence and disease epidemiology have instructed updated guidelines and practice patterns. 1 While there has been extensive investigation of clinical determinants to identify neonates at low risk for invasive bacterial infection (IBI), 2 there has been little investigation into the impact of sociodemographic characteristics on management of this population. The study by Gutman et al 3 in JAMA Pediatrics examines the impact of race, ethnicity, and language for care on interventions performed for well-appearing febrile infants at low risk for IBI by clinical criteria in pediatric emergency departments (EDs). Among 4042 well-appearing, clinically low-risk febrile infants, 969 (24%) had at least 1 unnecessary intervention, such as lumbar puncture, antibiotic administration, and/or hospitalization. The investigators found that language for care was significantly associated with at least 1 nonindicated intervention in clinically low-risk neonates. Infants of families that use a language other than English (LOE) had higher odds of inter vention overall (adjusted odds ratio = 1.16 [95% CI, 1.01-1.33]) and of hospital admission (adjusted odds ratio = 1.25 [95% CI, 1.08-1.46]) when compared with the grand mean.Gutman and colleagues were thoughtful in their use of statistical methods, centering comparisons on the grand mean (the average of averages, in other words) rather than on the experience of non-Hispanic White and English-speaking patients and families. Their subanalyses also provided some clarity in the complex interplay between race, ethnicity, and language, as they found that Hispanic patients (the majority of whom used English) were less likely to be hospitalized, and patients who used LOE (the majority of whom were Hispanic and used Spanish) were more likely to be hospitalized. There was no overall association between race and ethnicity and the primary outcome.Based on their findings, Gutman and colleagues conclude that inequitable care provision may stem from actual and perceived communication barriers, but they also point out that there is a solution for overcoming these barriers: the use of professional medical interpretation. Patients who need interpreters but do not have access to them experience compromised quality of care. 4 Conversely, care quality, satisfaction, and outcomes are all i m p r o v e d w i t h i m p r o v e d a c c e s s t o p r o f e s s i o n a l interpretation. 4,5 Despite these benefits, studies show that professional interpretation is underused across pediatric EDs. [4][5][6] Single-site efforts have endeavored to improve professional interpreter use, 7 but challenges remain in overcom-