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Chicoine N, Greenberg S, Barry D, Dick A, Cockrell H. Association Between Language, Interpreter Use, and Pediatric Surgical Outcomes. J Pediatr Surg 2025; 60:162104. [PMID: 39808857 DOI: 10.1016/j.jpedsurg.2024.162104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 05/15/2024] [Revised: 11/22/2024] [Accepted: 12/06/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Inequities exist in pediatric surgical outcomes. Differential outcomes have been identified across racial groups, geography, and socioeconomic standing. However, the association between preferred language, interpreter use, and surgical outcomes is not well-studied in pediatric surgical literature. METHODS We performed a retrospective cohort study of surgical patients ages 0-21 years at a quaternary pediatric hospital between 1/1/2016 - 12/31/2020. The 95 languages spoken by our cohort were grouped into English, Spanish, Asian languages, Other Indo-European languages, and Other languages. Study outcomes were 30-day post-operative mortality and serious adverse events (SAE). Logistic regression assessed the relationship between language, interpreter use, and post-operative outcomes. Deviation contrasts avoided centering non-Hispanic white English speakers. All-pairs comparisons (Turkey contrasts) determined differences between language groups. RESULTS Among 56,655 patients, 89 % had a documented language of English, 6.7 % Spanish, 1.4 % Other, 1.3 % an Asian language, and 1.3 % an Other Indo-European language. On multivariable regression, English speakers had 54 % decreased odds of mortality (OR 0.46, 95 % CI: 0.31, 0.69), while Other language speakers had 240 % increased odds of mortality (OR 2.4, 95 % CI: 1.31, 4.41). Pairwise comparisons showed that English language speakers had reduced odds of mortality versus Other language speakers (OR 0.18, 95 % CI: 0.07, 0.45). Interpreter use was associated with a significant reduction in the odds of SAE but did not reduce mortality risk. DISCUSSION Pediatric surgical patients with a linguistic minority preference experienced statistically significant increased odds of post-operative mortality. Additional inquiry to assess and address disparate pediatric surgical care outcomes associated with language is warranted. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nicole Chicoine
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Sarah Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Dwight Barry
- Department of Clinical Analytics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Andre Dick
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA; Section of Pediatric Transplant Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Hannah Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
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Khan AW, Dar MS, Nabi R, Ali A, Humayun MA, Riaz E. Acute pediatric appendicitis in black and white: clinical disparities, impact and future recommendations. Front Pediatr 2024; 12:1453927. [PMID: 39544339 PMCID: PMC11561711 DOI: 10.3389/fped.2024.1453927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/24/2024] [Accepted: 10/08/2024] [Indexed: 11/17/2024] Open
Abstract
Racial and ethnic disparities have long been studied in the delivery of healthcare. One such avenue is acute pediatric appendicitis, which continues to be an area of significant and continual research. Because of its routine clinical presentation and standardized management, acute pediatric appendicitis serves as an appropriate proxy for studying discrepancies in healthcare. Our review therefore aims to comprehensively highlight the various dimensions of its clinical management subject to disparities, their collective clinical impact, and future recommendations to mitigate it.
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Affiliation(s)
- Aimen Waqar Khan
- Department of Accident and Emergency, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Marrium Sultan Dar
- Department of Internal Medicine, Medical ICU, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Rayyan Nabi
- Department of Internal Medicine, Islamic International Medical College, Riphah International University, Karachi, Pakistan
| | - Ahmad Ali
- King Edward Medical University, Lahore, Pakistan
| | | | - Eman Riaz
- Department of Internal Medicine, Ayub Medical College, Abbottabad, Pakistan
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Liu O, van Gelderen E, Giwa G, Biswas A, Nair S, Garcia AV, Chidiac C, Rhee DS. A Scoping Review of Limited English Proficiency and Immigration in Pediatric Surgery. J Surg Res 2024; 302:540-554. [PMID: 39178570 DOI: 10.1016/j.jss.2024.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/05/2024] [Revised: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION With increasing globalization and diversity, the intersection of immigration and language barriers can impact patient outcomes. This scope review aims to summarize current evidence on immigration and language barriers on pediatric surgical outcomes. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched with Medical Subject Heading terms describing pediatric surgery, immigration, limited English proficiency (LEP), and refugees between 2000-2023. Four independent reviewers screened and analyzed texts for final inclusion. RESULTS Thirty-three studies were included. Ten studies described disease incidence and severity, finding that LEP, immigrant, and refugee patients were more likely to present with severe disease in appendicitis and traumatic injuries. five studies described pain management, finding patients with LEP received fewer pain assessments, waited longer for analgesia, and had more discrepancies in pain scores. Seventeen studies investigated treatment receipt and delay, finding that immigrants and patients with LEP had longer time to and reduced rates of treatment. Seventeen studies described surgical outcomes, finding that patients with LEP have longer length of stay and more postoperative emergency department visits but fewer follow-up appointments. In kidney transplants, patients with LEP and immigrants had worse outcomes, but these trends are not seen in immigrants from Europe. Overall, immigrants and refugees have higher rates of complications and mortality. CONCLUSIONS Immigrants and patients with LEP and are more likely to present with advanced disease and severe injuries, receive inadequate pain management, experience delays in surgery, and suffer more complications. There is continued need to assess the impact of LEP and immigration on pediatric surgery outcomes.
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Affiliation(s)
- Olivia Liu
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Ganiat Giwa
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arushi Biswas
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shuait Nair
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charbel Chidiac
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Liu O, Hernandez-Munoz V, Giwa G, Gorijavolu R, Chidiac C, Garcia AV, Rhee DS. Evaluation of Limited English Proficiency in the Management and Outcomes of Appendicitis in Children. J Surg Res 2024; 302:446-453. [PMID: 39154425 DOI: 10.1016/j.jss.2024.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/06/2024] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Appendectomies are one of the most common pediatric surgical procedures. Limited English proficiency (LEP) may lead to disparities in health outcomes between English-proficient and LEP patients. This study assesses the association between LEP and postoperative outcomes in pediatric appendectomy. METHODS We analyzed records from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2010 to 2023 under 18 y of age undergoing appendectomy at our institution. LEP was defined as the need for an interpreter. Primary outcomes were postoperative complications, length of stay (LOS), and postoperative emergency department (ED) visits within 30 d of discharge. Multivariable analyses were performed. RESULTS One thousand one hundred forty three children with appendicitis were identified, with 208 (18.2%) LEP and 935 (81.8%) English-proficient patients. LEP children were more likely to present with complicated appendicitis (42.8% versus 25.5%, P < 0.0001) and sepsis (34.1% versus 21.6%, P = 0.0003). LEP patients experience more serious (8.6% versus 3.9%, P = 0.02), overall complications (10.1% versus 5.5%, P = 0.006), and organ/surgical space site infections (8.2% versus 3.3%, P = 0.003). On multivariable analysis controlling for ethnicity and factors associated with complicated presentation, LEP was associated with increased postoperative ED visits (adjusted odds ratio [aOR] 2.64, 95% confidence interval [CI] = 1.40-4.39), but not LOS (aOR 1.86, 95% CI = 0.87-3.97) or complications (aOR 1.76, 95% CI = 0.79-4.00). CONCLUSIONS LEP is independently associated with increased postoperative ED visits. Higher rates of complications and longer LOS may be related to increased complicated appendicitis at presentation. The role of cultural preferences and other social determinants of health that contribute to these disparities needs more investigation.
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Affiliation(s)
- Olivia Liu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ganiat Giwa
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rahul Gorijavolu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charbel Chidiac
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Lim PS, Fortier MA, Kain ZN. Pain Disparities Attributed to Linguistic Minoritization in Health Care Settings. THE JOURNAL OF PAIN 2024:104688. [PMID: 39357614 DOI: 10.1016/j.jpain.2024.104688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Academic Contribution Register] [Received: 04/30/2024] [Revised: 09/17/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
There is a paucity of understanding about how language influences pain communication and outcomes for families who speak languages other than English in the United States. This is of great importance because 21.6% (68 million) of the population speak a language other than English, with 8% (25 million) of the population speaking English "less than very well." Thus, the aim of this paper is to present a narrative review that describes how spoken language influences pediatric pain assessment and outcomes for children who speak languages other than English and discuss hypothesized factors that contribute to pain disparities in hospital settings. Results from the narrative review reveal that children and families who speak languages other than English have disparate pain outcomes compared with children from English-speaking families. It is hypothesized that individual (eg, clinician bias), interpersonal (eg, miscommunication of pain concepts), cultural (eg, misunderstanding of cultural concepts of pain), and systemic (eg, lack of access to interpretation services) factors influence disparate pain outcomes for linguistically minoritized children. Empirical research, including randomized control trials, regarding hypothesized factors that contribute to pediatric pain disparities for language other than English-speaking children, is severely lacking. Thus, improved understanding of pain concepts and pain communication processes that center individual, interpersonal, cultural, and systemic factors will enable future research to design interventions that enhance culturally relevant pain assessment and management for families who speak languages other than English. PERSPECTIVE: This article summarizes factors that contribute to pain disparities for children who speak languages other than English. Hypothesized factors that contribute to pain disparities for language other than English-speaking children and families include clinician bias, misunderstanding of pain concepts, and lack of access to interpretation services.
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Affiliation(s)
- Paulina S Lim
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California; UCI Center on Stress and Health, University of California Irvine, Irvine, California.
| | - Michelle A Fortier
- UCI Center on Stress and Health, University of California Irvine, Irvine, California; Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California; Children's Hospital of Orange County, Orange, California
| | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California; UCI Center on Stress and Health, University of California Irvine, Irvine, California; Children's Hospital of Orange County, Orange, California
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Zamor RL, Liberman DB, Hall JE, Rees CA, Hartford EA, Chaudhari PP, Portillo EN, Johnson MD. Collecting Sociodemographic Data in Pediatric Emergency Research: A Working Group Consensus. Pediatrics 2024; 154:e2023065277. [PMID: 39044723 PMCID: PMC11291964 DOI: 10.1542/peds.2023-065277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 12/18/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/25/2024] Open
Abstract
Understanding and addressing health care disparities relies on collecting and reporting accurate data in clinical care and research. Data regarding a child's race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic characteristics are important to ensure equity in research practices and reported outcomes. Disparities are known to exist across these sociodemographic categories. More consistent, accurate data collection could improve understanding of study results and inform approaches to resolve disparities in child health. However, published guidance on standardized collection of these data in children is limited, and given the evolving nature of sociocultural identities, requires frequent updates. The Pediatric Emergency Care Applied Research Network, a multi-institutional network dedicated to pediatric emergency research, developed a Health Disparities Working Group in 2021 to support and advance equitable pediatric emergency research. The working group, which includes clinicians involved in pediatric emergency medical care and researchers with expertise in pediatric disparities and the conduct of pediatric research, prioritized creating a guide for approaches to collecting race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic data during the conduct of research in pediatric emergency care settings. Our aims with this guide are to summarize existing barriers to sociodemographic data collection in pediatric emergency research, highlight approaches to support the consistent and reproducible collection of these data, and provide rationale for suggested approaches. These approaches may help investigators collect data through a process that is inclusive, consistent across studies, and better informs efforts to reduce disparities in child health.
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Affiliation(s)
- Ronine L. Zamor
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeanine E. Hall
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Emily A. Hartford
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
| | - Elyse N. Portillo
- Division of Pediatric Emergency medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Michael D. Johnson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Trinidad S, Parrado R, Hoang M, Toraman Turk S, Unaka N, Beck AF, Schondelmeyer A, Kotagal M. Potential causes of delays in paediatric perforated appendicitis: A prospective interview study. J Paediatr Child Health 2024; 60:193-199. [PMID: 38695512 DOI: 10.1111/jpc.16556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 11/15/2023] [Revised: 12/13/2023] [Accepted: 04/19/2024] [Indexed: 07/07/2024]
Abstract
AIM Delays in care may be a driver of inequities in perforated appendicitis rates. The goal of this study was to explore potential causes of delay in care for children with perforated appendicitis. METHODS We conducted an interview study of caregivers of children admitted with perforated appendicitis to a children's hospital between December 2022 and March 2023. Semi-structured interviews based on an iteratively revised interview guide were conducted in-person during the child's admission. All interviews were transcribed, coded and underwent a process of thematic analysis. RESULTS We reached thematic saturation after 12 interviews. The median age for children was 13.5 years, 50% were male, 83% of caregivers self-identified as White, and one interview required an interpreter. Through thematic analysis, four major themes for potential causes of delay emerged. The first theme of symptom recognition includes delays related to recognising the symptoms, their severity and the need for medical evaluation. The second theme - accessing care - describes delays that occur after a decision was made to seek care until the child was evaluated. The third theme includes delays that occur in making the diagnosis after evaluation. The last theme captures potential delays in definitive treatment after a diagnosis of appendicitis is made. CONCLUSION We identify four major themes from the patient and family perspective, each with multiple sub-themes, for potential delays in definitive care for children with perforated appendicitis. Additional research is needed to further characterise these potential delays and quantify their role in contributing to inequities in perforation rates.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Raphael Parrado
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Mindy Hoang
- Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Sinem Toraman Turk
- Department of Health Policy and Management, Global Health Leadership Initiative, Yale University, New Haven, Connecticut, United States
| | - Ndidi Unaka
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Michael A. Fisher Child Health Equity Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Michael A. Fisher Child Health Equity Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Amanda Schondelmeyer
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Trinidad S, Parrado R, Gavulic A, Hoang M, Duan Q, Overmann KM, Unaka N, Beck AF, Kotagal M. Characterizing Inequities in Pediatric Appendicitis Delayed Diagnosis and Perforation. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 11:200108. [PMID: 38827485 PMCID: PMC11138256 DOI: 10.1016/j.jpedcp.2024.200108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Academic Contribution Register] [Received: 11/26/2023] [Revised: 03/09/2024] [Accepted: 03/09/2024] [Indexed: 06/04/2024]
Abstract
Objective We sought to characterize the impact of a child's sociodemographic characteristics on their odds of delayed diagnosis and perforation in pediatric appendicitis. Study design We performed a single-center, retrospective cohort study of all pediatric appendicitis admissions between 2016 and 2021. Using a multivariable model, we evaluated for associations between delayed diagnosis and perforation and a child's sociodemographic characteristics, including their age, sex, race and ethnicity, insurance status, and their home census-tract Material Community Deprivation Index value. Results The study included 3248 patients. The median age was 12.1 years (IQR 9.5-14.9 years). Most patients were male (60.3%), identified as non-Hispanic White (78.0%), and had private insurance (55.4%). The delayed diagnosis and perforation rates were 6.4% and 25.1%, respectively. Delayed diagnosis cases had a greater perforation rate (56% compared with 21.5%, P < .001). On adjusted analysis, older age decreased the odds (OR 0.91, CI 0.87-0.94) of delayed diagnosis, whereas female sex (OR 1.50, CI 1.13-2.00) and socioeconomic disadvantage (OR 1.56 for quartile 4 vs quartile 1, CI 1.00-2.43) increased the odds. Furthermore, older age (OR 0.91, CI 0.89-0.93) decreased the odds of perforation, whereas non-Hispanic Black (OR 1.72, CI 1.3-2.29) or Hispanic (OR 1.60, CI 1.24-2.08) compared with non-Hispanic White identification and socioeconomic disadvantage (OR 1.43 Q4 vs Q1, CI 1.12-1.83) increased the odds. Conclusions Our reported delayed diagnosis rate is greater than recent literature, highlighting the need to consider visits that occur across different health care settings. We further identify sociodemographic factors, including socioeconomic status, that impact a child's risk of delayed diagnosis and perforation.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Raphael Parrado
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Amelia Gavulic
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mindy Hoang
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Qing Duan
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kevin M. Overmann
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ndidi Unaka
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Michael A. Fisher Child Health Equity Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Office of Population Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Andrew F. Beck
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Michael A. Fisher Child Health Equity Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Office of Population Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Chidiac C, Liu O, Gorijavolu R, Rhee DS, Garcia AV. Ethnic disparities in pediatric appendicitis: the impact of hispanic ethnicity on presentation, complications, and postoperative outcomes. Int J Colorectal Dis 2024; 39:29. [PMID: 38386177 PMCID: PMC10884102 DOI: 10.1007/s00384-024-04598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Our study investigates ethnic disparities in pediatric appendicitis, focusing on the impact of Hispanic ethnicity on presentation, complications, and postoperative outcomes. METHODS We conducted a retrospective analysis of pediatric patients undergoing appendectomy for acute appendicitis from 2015 to 2020 using the National Surgical Quality Improvement Program-Pediatric database. We compared 30-day postoperative complications, postoperative length of stay, and postoperative interventions between Hispanic and non-Hispanic White patients. RESULTS 65,976 patients were included, of which 23,462 (35.56%) were Hispanic and 42,514 (64.44%) non-Hispanic White. Hispanic children were more likely to present to the hospital with complicated appendicitis (31.75% vs. 25.15%, P < 0.0001) and sepsis (25.22% vs. 19.02%, P < 0.0001) compared to non-Hispanic White. Hispanics had higher rates of serious complications (4.06% vs. 3.55%, P = 0.001) but not overall complications (5.37% vs. 5.09%, P = 0.12). However, after multivariate analysis, Hispanic ethnicity was not associated with an increased rate of serious postoperative complications (OR 0.93, CI 0.85-1.01, P = 0.088); it was associated with less overall complications (OR 0.88, CI 0.81-0.96, P = 0.003) but a longer postoperative length of stay (OR 1.09, CI 1.04-1.14, P < 0.0001). CONCLUSION Hispanic children are more likely to present with complicated appendicitis, contributing to increased postoperative complications. Notably, upon adjustment for the impact of complicated appendicitis, our findings suggest potentially favorable outcomes for Hispanic ethnicity. This emphasizes the need to understand delays in presentation to improve outcomes in the Hispanic population.
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Affiliation(s)
- Charbel Chidiac
- Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St Suite 7335, Baltimore, MD, 21287, USA
| | - Olivia Liu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St Suite 7335, Baltimore, MD, 21287, USA
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St Suite 7335, Baltimore, MD, 21287, USA.
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Lowe JT, Leonard J, Dominguez F, Widmer K, Deakyne Davies SJ, Wiersma AJ, Mendenhall M, Grubenhoff JA. Preferred language and diagnostic errors in the pediatric emergency department. Diagnosis (Berl) 2024; 11:49-53. [PMID: 37795819 DOI: 10.1515/dx-2023-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
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.
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Affiliation(s)
| | - Jan Leonard
- Children's Hospital of Philadelphia, Philadelphia, PN, USA
| | | | - Kaitlin Widmer
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | | | - Alexandria J Wiersma
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Marcela Mendenhall
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Joseph A Grubenhoff
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
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Bakillah E, Finn CB, Sharpe J, Kelz RR. The effect of Section 1557 of the Affordable Care Act on surgical outcomes in non-English primary language speakers. Am J Surg 2024; 227:189-197. [PMID: 37852843 DOI: 10.1016/j.amjsurg.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/21/2023] [Revised: 09/01/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In 2016, Section 1557 mandated use of qualified language interpreter services. We examined the effect of Section 1557 on surgical outcomes. METHODS Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2013-2020), we performed a difference-in-differences analysis of adult surgical patients (Maryland, New Jersey). The exposure was implementation of Section 1557 (pre-period: 2013-2015; post-period: 2017-2020). The treatment group was non-English primary language speakers (n-EPL). The comparison group was English primary language speakers (EPL). Outcomes included length-of-stay, postoperative complications, mortality, discharge disposition, and readmissions. RESULTS Among 2,298,584 patients, 198,385 (8.6%) were n-EPL. After implementation of Section 1557, n-EPL saw no difference in readmission rates but did experience significantly higher rates of mortality (+0.43%, p = 0.049) and non-routine discharges (+1.81%, p = 0.031) in Maryland, and higher rates of post-operative complications (+0.31%, p = 0.001) in both states, compared to pre-Section 1557. CONCLUSIONS Contrary to our hypothesis, Section 1557 did not improve surgical outcomes for n-EPL.
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Affiliation(s)
- Emna Bakillah
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Caitlin B Finn
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - James Sharpe
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Emmanuel M, Margolis R, Badh R, Kachroo N, Teach SJ, Parikh K. Caregiver Language Preference and Health Care Utilization Among Children With Asthma. Pediatrics 2023; 152:e2023061869. [PMID: 37964708 DOI: 10.1542/peds.2023-061869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Asthma is a leading cause of health care utilization in children and disproportionately affects historically marginalized populations. Yet, limited data exist on the role of caregiver language preference on asthma morbidity. The study aim was to determine whether caregiver non-English language preference (NELP) is associated with unscheduled asthma-related health care utilization in pediatric patients. METHODS This was a retrospective cohort study using data from a population-level, disease-specific registry of pediatric patients with asthma living in the District of Columbia (DC). Patients aged 2 to 17 years were included and the study period was 2019. The primary exposure variable was language preference: English preferred (EP) or NELP by self-identified language preference. The primary outcome was unscheduled asthma-related health care utilization including emergency department visits, hospitalizations (ICU and non-ICU), and ICU visits alone. Logistic regression was used to calculate adjusted odds ratios (aORs). RESULTS Of the 14 431 patients included, 8.1% had NELP (1172 patients). In analyses adjusted for age, sex, ethnicity, insurance status, diagnosis of persistent asthma, controller prescription, and encounter with a primary care provider, caregiver NELP was associated with an increased odds of having an asthma-related emergency department visit (aOR, 1.37; 95% CI, 1.08-1.74), hospitalization (aOR, 1.79; 95% CI, 1.18-2.72), and ICU visit (aOR, 4.37; 95% CI, 1.93-9.92). In the Hispanic subgroup (n = 1555), caregiver NELP was associated with an increased odds of having an asthma-related hospitalization (aOR, 1.73; 95% CI, 1.02-2.93). CONCLUSIONS In the population of children in the District of Columbia with asthma, caregiver NELP was associated with increased odds of asthma-related health care utilization, suggesting that caregiver language preference is a significant determinant of asthma outcomes.
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Affiliation(s)
| | | | | | | | - Stephen J Teach
- Division of Emergency Medicine
- Center for Translational Research
| | - Kavita Parikh
- Center for Translational Research
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
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Trinidad S, Goldshore M, Kotagal M. Addressing health equity in pediatric surgical care in the United States- Progress and challenges. Semin Pediatr Surg 2023; 32:151354. [PMID: 37967486 DOI: 10.1016/j.sempedsurg.2023.151354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2023]
Abstract
There are notable inequities in health outcomes for children based on their social determinants of health (SDOH), including where they are born and live, their primary language, their race and ethnicity, socioeconomic status, and more. These health inequities are not restricted to resource limited settings; here we highlight three broad topics that are relevant to pediatric surgeons in the United States (US): access to care and disparities, and examples of inequities in firearm-related injuries and appendicitis. Most of our patients will at some point require operative interventions, yet there can be significant challenges in accessing this care and navigating our health systems, particularly around complex perioperative care. There are significant opportunities to improve equitable care by helping patients navigate our health systems and connecting them with additional resources, including screening for primary care services. Firearm-related injuries are now the leading cause of death in children in the US, with significant associated morbidity for non-fatal injuries. There are notable inequities in the risk of injury and types of injuries experienced by children based on their SDOH. Appendicitis is one of the most common pathologies managed by pediatric surgeons, with similar inequities in the rates of perforated appendicitis based on a child's SDOH. For both issues, addressing the inequities our patients experience requires moving upstream and working towards prevention. Key opportunities include better research and data to understand the drivers for observed inequities, multidisciplinary collaboration, community engagement, and public health advocacy among others. As a profession, we have a responsibility to work to address the health inequities our patients experience.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Matthew Goldshore
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Gil LA, Asti L, Beyene TJ, Cooper JN, Minneci PC, Besner GE. Inequities in the Diagnosis of Pediatric Appendicitis in Tertiary Children's Hospitals and the Consequences of Delayed Diagnosis. J Surg Res 2023; 292:158-166. [PMID: 37619501 DOI: 10.1016/j.jss.2023.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/28/2023] [Revised: 06/11/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Missed diagnosis (MD) of acute appendicitis is associated with increased risk of appendiceal perforation. This study aimed to investigate whether racial/ethnic disparities exist in the diagnosis of pediatric appendicitis by comparing rates of MD versus single-encounter diagnosis (SED) between racial/ethnic groups. METHODS Patients 0-18 y-old admitted for acute appendicitis from February 2017 to December 2021 were identified in the Pediatric Health Information System (PHIS). International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes for Emergency Department visits within 7 d prior to diagnosis were evaluated to determine whether the encounter represented MD. Generalized mixed models were used to assess the association between MD and patient characteristics. A similar model assessed independent predictors of perforation. RESULTS 51,164 patients admitted for acute appendicitis were included; 50,239 (98.2%) had SED and 925 (1.8%) had MD. Compared to non-Hispanic White patients, patients of non-Hispanic Black (odds ratio 2.5, 95% confidence interval 2.0-3.1), Hispanic (2.1, 1.8-2.5), and other race/ethnicity (1.6, 1.2-2.1) had higher odds of MD. There was a significant interaction between race/ethnicity and imaging (P < 0.0001). Among patients with imaging, race/ethnicity was not significantly associated with MD. Among patients without imaging, there was an increase in strength of association between race/ethnicity and MD (non-Hispanic Black 3.6, 2.7-4.9; Hispanic 3.3, 2.6-4.1; other 2.0, 1.4-2.8). MD was associated with increased risk of perforation (2.5, 2.2-2.8). CONCLUSIONS Minority children were more likely to have MD. Future efforts should aim to mitigate the risk of MD, including implementation of algorithms to standardize the workup of abdominal pain to reduce potential consequences of implicit bias.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Gail E Besner
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
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Segal KR, Gomez JA, Schulz JF, Alvandi LM, Fornari ED. The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management. Hosp Pediatr 2023; 13:1001-1009. [PMID: 37850258 DOI: 10.1542/hpeds.2023-007232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85). CONCLUSIONS As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
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Portillo EN, Rees CA, Hartford EA, Foughty ZC, Pickett ML, Gutman CK, Shihabuddin BS, Fleegler EW, Chumpitazi CE, Johnson TJ, Schnadower D, Shaw KN. Research Priorities for Pediatric Emergency Care to Address Disparities by Race, Ethnicity, and Language. JAMA Netw Open 2023; 6:e2343791. [PMID: 37955894 PMCID: PMC10644218 DOI: 10.1001/jamanetworkopen.2023.43791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Importance Health care disparities are well-documented among children based on race, ethnicity, and language for care. An agenda that outlines research priorities for disparities in pediatric emergency care (PEC) is lacking. Objective To investigate research priorities for disparities in PEC among medical personnel, researchers, and health care-affiliated community organizations. Design, Setting, and Participants In this survey study, a modified Delphi approach was used to investigate research priorities for disparities in PEC. An initial list of research priorities was developed by a group of experienced PEC investigators in 2021. Partners iteratively assessed the list through 2 rounds of electronic surveys using Likert-type responses in late 2021 and early 2022. Priorities were defined as achieving consensus if they received a score of highest priority or priority by at least 60% of respondents. Asynchronous engagement of participants via online web-conferencing platforms and email correspondence with electronic survey administration was used. Partners were individuals and groups involved in PEC. Participants represented interest groups, research and medical personnel organizations, health care partners, and laypersons with roles in community and family hospital advisory councils. Participants were largely from the US, with input from international PEC research networks. Outcome Consensus agenda of research priorities to identify and address health care disparities in PEC. Results PEC investigators generated an initial list of 27 potential priorities. Surveys were completed by 38 of 47 partners (80.6%) and 30 of 38 partners (81.1%) in rounds 1 and 2, respectively. Among 30 respondents who completed both rounds, there were 7 family or community partners and 23 medical or research partners, including 4 international PEC research networks. A total of 12 research priorities achieved the predetermined consensus threshold: (1) systematic efforts to reduce disparities; (2) race, ethnicity, and language data collection and reporting; (3) recognizing and mitigating clinician implicit bias; (4) mental health disparities; (5) social determinants of health; (6) language and literacy; (7) acute pain-management disparities; (8) quality of care equity metrics; (9) shared decision-making; (10) patient experience; (11) triage and acuity score assignment; and (12) inclusive research participation. Conclusions and Relevance These results suggest a research priority agenda that may be used as a guide for investigators, research networks, organizations, and funding agencies to engage in and support high-priority disparities research topics in PEC.
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Affiliation(s)
- Elyse N. Portillo
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Emily A. Hartford
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle
| | - Zachary C. Foughty
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Michelle L. Pickett
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Colleen K. Gutman
- Department of Emergency Medicine, University of Florida, Gainesville
- Department of Pediatrics, University of Florida, Gainesville
| | - Bashar S. Shihabuddin
- Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Corrie E. Chumpitazi
- Division of Emergency Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Tiffani J. Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathy N. Shaw
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia
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Handler C, Weiner N, Meir E, Abu-Hatoum O, Kopelman D, Kaplan U. Is acute appendicitis more severe in foreign workers of northern Israel? A retrospective cohort study. Eur J Trauma Emerg Surg 2023; 49:2235-2240. [PMID: 35524779 DOI: 10.1007/s00068-022-01980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/03/2021] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute appendicitis (AA) is one of the most common surgical emergencies worldwide. It's classified into simple or complicated disease. Due to the high prevalence of the disease, AA has been studied as a marker to assess the quality of care afforded to minority groups. The purpose of this study was to compare AA outcomes in foreign workers (FW) to the general population in northern Israel. METHODS This is a retrospective cohort study. We identified all patients aged 18-50 who were admitted to our institution between January 1st, 2013 and October 31st, 2018, with the diagnosis of acute appendicitis. The study group included all FW and the control group included citizens of Israel. Study patients were matched based on age, sex, and co-morbidities. We compared time to presentation, admission parameters and disease outcomes. Our study outcomes were disease severity and length of hospital stay. RESULTS We identified 20 FW and 97 matched local patients. FW presented with significantly higher heart rate, temperature, and white blood cell count (WBC). Duration of symptoms was comparable between the two groups. The rates of complicated disease were significantly higher among FW (45 vs 17.5%, p < 0.0001). Length of hospitalization was significantly longer in the FW group (4.8 vs. 3.9 days, p = 0.01). The odds ratio of FWs for having a complicated disease was OR = 3.85 [95% CI: 1.38, 10.72], p = 0.01. Multivariate analysis identified FW and duration of symptoms as significantly contributing to a complicated disease outcome. CONCLUSIONS Although duration of symptoms was comparable to the local population, FW in northern Israel are at increased risk for a complicated disease which resulted in longer hospital stay. Further studies may enlighten the reason for this disparity.
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Affiliation(s)
- Chovav Handler
- Department of General Surgery, Ziv Medical Center, Rambam St, 13100, Zefat, Israel
| | - Noam Weiner
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Eyal Meir
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
| | - Ossama Abu-Hatoum
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron st. 1, Bat Galim, 3525433, Haifa, Israel
| | - Doron Kopelman
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron st. 1, Bat Galim, 3525433, Haifa, Israel
| | - Uri Kaplan
- Department of General Surgery B., Emek Medical Center, Yitshak Rabin Boulevard 21, 1834111, Afula, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron st. 1, Bat Galim, 3525433, Haifa, Israel.
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Rogo T, Holland S. Impact of health disparity on pediatric infections. Curr Opin Infect Dis 2023; 36:394-398. [PMID: 37466089 DOI: 10.1097/qco.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic highlighted the health disparities among minoritized children due to structural racism and socioeconomic inequalities. This review discusses how health disparities affect pediatric infections and how they can be addressed. RECENT FINDINGS In addition to disparities in healthcare access due to poverty, geography, and English-language proficiency, implicit and explicit bias affects the healthcare quality and subsequent outcomes in children and adolescents with infections. Disparities in clinical trial enrollment affect the generalizability of research findings. Physicians who understand their patients' languages and the contexts of culture and socioeconomic conditions are better equipped to address the needs of specific populations and the health disparities among them. SUMMARY Addressing disparities in pediatric infections requires prioritization of efforts to increase physician workforce diversity in Pediatric Infectious Diseases, as well as education in bias reduction and culturally sensitive clinical practice, in addition to socioeconomic interventions that improve healthcare access, delivery, and outcomes.
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Affiliation(s)
- Tanya Rogo
- Division of Pediatric Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Shah P, Skjei K. Health Disparities for Immigrant Children: Focus on Epilepsy. Pediatr Ann 2023; 52:e373-e380. [PMID: 37820703 DOI: 10.3928/19382359-20230829-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 10/13/2023]
Abstract
Although health and health care disparities between immigrant and native-born adult populations in the United States are well documented, the pediatric literature is limited. Data suggest first- and second- generation immigrant children have worse health outcomes when compared with their native-born counterparts because of factors such as socioeconomic status, insurance and language barriers, authorization status, and bias/xenophobia. This article takes a broad look at existing research regarding health barriers for immigrant children, then focuses on the pediatric epilepsy literature to highlight the complex interplay of these disparity factors. Finally, we review the literature on existing interventions, including language concordance, community-driven educational efforts, and broad-scale policy changes that can be used to promote health equity in pediatric epilepsy and beyond. Research gaps are also identified. [Pediatr Ann. 2023;52(10):e373-e380.].
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Truong S, Foley OW, Fallah P, Lalla AT, Osterbur Badhey M, Boatin AA, Mitchell CM, Bryant AS, Molina RL. Transcending Language Barriers in Obstetrics and Gynecology: A Critical Dimension for Health Equity. Obstet Gynecol 2023; 142:809-817. [PMID: 37678884 PMCID: PMC10510840 DOI: 10.1097/aog.0000000000005334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/02/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 09/09/2023]
Abstract
There is growing evidence that language discordance between patients and their health care teams negatively affects quality of care, experience of care, and health outcomes, yet there is limited guidance on best practices for advancing equitable care for patients who have language barriers within obstetrics and gynecology. In this commentary, we present two cases of language-discordant care and a framework for addressing language as a critical lens for health inequities in obstetrics and gynecology, which includes a variety of clinical settings such as labor and delivery, perioperative care, outpatient clinics, and inpatient services, as well as sensitivity around reproductive health topics. The proposed framework explores drivers of language-related inequities at the clinician, health system, and societal level. We end with actionable recommendations for enhancing equitable care for patients experiencing language barriers. Because language and communication barriers undergird other structural drivers of inequities in reproductive health outcomes, we urge obstetrician-gynecologists to prioritize improving care for patients experiencing language barriers.
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Affiliation(s)
- Samantha Truong
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and the Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, Illinois
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Serrano E, Voldal EC, Machado-Aranda D, DeUgarte DA, Kao L, Drake T, Winchell R, Cuschieri J, Krishnadasan A, Talan DA, Siparsky N, Ayoung-Chee P, Self WH, McGonagill P, Mandell KA, Liang MK, Dodwad SJ, Thompson CM, Padilla RM, Fleischman R, Price TP, Jones A, Bernardi K, Garcia L, Evans HL, Sanchez SE, Odom S, Comstock BA, Heagerty PJ, Lawrence SO, Monsell SE, Fannon EE, Kessler LG, Flum DR, Davidson GH. Trial Participation and Outcomes Among English-Speaking and Spanish-Speaking Patients With Appendicitis Randomized to Antibiotics: A Secondary Analysis of the CODA Randomized Clinical Trial. JAMA Surg 2023; 158:901-908. [PMID: 37379001 PMCID: PMC10308294 DOI: 10.1001/jamasurg.2023.2277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 06/29/2023]
Abstract
Importance Spanish-speaking participants are underrepresented in clinical trials, limiting study generalizability and contributing to ongoing health inequity. The Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial intentionally included Spanish-speaking participants. Objective To describe trial participation and compare clinical and patient-reported outcomes among Spanish-speaking and English-speaking participants with acute appendicitis randomized to antibiotics. Design, Setting, and Participants This study is a secondary analysis of the CODA trial, a pragmatic randomized trial comparing antibiotic therapy with appendectomy in adult patients with imaging-confirmed appendicitis enrolled at 25 centers across the US from May 1, 2016, to February 28, 2020. The trial was conducted in English and Spanish. All 776 participants randomized to antibiotics are included in this analysis. The data were analyzed from November 15, 2021, through August 24, 2022. Intervention Randomization to a 10-day course of antibiotics or appendectomy. Main Outcomes and Measures Trial participation, European Quality of Life-5 Dimensions (EQ-5D) questionnaire scores (higher scores indicating a better health status), rate of appendectomy, treatment satisfaction, decisional regret, and days of work missed. Outcomes are also reported for a subset of participants that were recruited from the 5 sites with a large proportion of Spanish-speaking participants. Results Among eligible patients 476 of 1050 Spanish speakers (45%) and 1076 of 3982 of English speakers (27%) consented, comprising the 1552 participants who underwent 1:1 randomization (mean age, 38.0 years; 976 male [63%]). Of the 776 participants randomized to antibiotics, 238 were Spanish speaking (31%). Among Spanish speakers randomized to antibiotics, the rate of appendectomy was 22% (95% CI, 17%-28%) at 30 days and 45% (95% CI, 38%-52%) at 1 year, while in English speakers, these rates were 20% (95% CI, 16%-23%) at 30 days and 42% (95% CI 38%-47%) at 1 year. Mean EQ-5D scores were 0.93 (95% CI, 0.92-0.95) among Spanish speakers and 0.92 (95% CI, 0.91-0.93) among English speakers. Symptom resolution at 30 days was reported by 68% (95% CI, 61%-74%) of Spanish speakers and 69% (95% CI, 64%-73%) of English speakers. Spanish speakers missed 6.69 (95% CI, 5.51-7.87) days of work on average, while English speakers missed 3.76 (95% CI, 3.20-4.32) days. Presentation to the emergency department or urgent care, hospitalization, treatment dissatisfaction, and decisional regret were low for both groups. Conclusions and Relevance A high proportion of Spanish speakers participated in the CODA trial. Clinical and most patient-reported outcomes were similar for English- and Spanish-speaking participants treated with antibiotics. Spanish speakers reported more days of missed work. Trial Registration ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
- Elina Serrano
- University of Washington, Seattle
- Fred Hutch Cancer Center, Seattle, Washington
| | - Emily C. Voldal
- University of Washington, Seattle
- Fred Hutch Cancer Center, Seattle, Washington
| | | | | | - Lillian Kao
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | | | | | - Joseph Cuschieri
- Harborview Medical Center, UW Medicine, Seattle, Washington
- University of California, San Francisco, San Francisco
| | | | - David A. Talan
- Olive View–UCLA Medical Center, Los Angeles, California
- Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | - Patricia Ayoung-Chee
- Bellevue Hospital Center, NYU School of Medicine, New York, New York
- Tisch Hospital, NYU Langone Medical Center, New York, New York
- Morehouse School of Medicine, Atlanta GA
| | - Wesley H. Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Mike K. Liang
- Lyndon B. Johnson General Hospital, University of Texas, Houston
- University of Houston, HCA Healthcare, Kingwood, Kingwood, Texas
| | - Shan-Jahan Dodwad
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | - Callie M. Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee
- University of Utah, Salt Lake City
| | | | | | | | - Alan Jones
- The University of Mississippi Medical Center, Jackson
| | - Karla Bernardi
- Lyndon B. Johnson General Hospital, University of Texas, Houston
| | - Luis Garcia
- University of Iowa Hospitals and Clinics, Iowa City
| | - Heather L. Evans
- Harborview Medical Center, UW Medicine, Seattle, Washington
- The Medical University of South Carolina, Charleston
| | | | - Stephen Odom
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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22
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Rojas CR, Chamberlain JM, Cohen JS, Badolato GM, Cook LJ, Goyal MK, Berkowitz D. Undertriage for Children With Caregivers Preferring Languages Other Than English. Pediatrics 2023:191273. [PMID: 37190962 DOI: 10.1542/peds.2022-059386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Accepted: 02/27/2023] [Indexed: 05/17/2023] Open
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.
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Affiliation(s)
- Christina R Rojas
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Joanna S Cohen
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Gia M Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - 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
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Deena Berkowitz
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
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23
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Rojas CR, Coffin A, Taylor A, Ortiz P, Jenicek G, Hart J, Callahan JM, Shaw KN. Resident Communication With Patients and Families Preferring Languages Other Than English. Hosp Pediatr 2023:191228. [PMID: 37125495 DOI: 10.1542/hpeds.2022-007003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS This was a cross-sectional study at a quaternary care children's hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported "sometimes" or "usually" communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07-0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13-0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30-0.69). CONCLUSIONS Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.
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Affiliation(s)
- Christina R Rojas
- Department of Pediatrics
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; and
| | | | | | | | | | - Jessica Hart
- Department of Pediatrics
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Callahan
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathy N Shaw
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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24
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Parrado RH, Cina RA. Does the Hispanic Paradox Apply to Children? An Appraisal of Pediatric Appendicitis in the U.S. J Pediatr Surg 2023:S0022-3468(23)00180-X. [PMID: 37015841 DOI: 10.1016/j.jpedsurg.2023.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Robert A Cina
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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25
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Bisht J, Rawat P, Sehar U, Reddy PH. Caregivers with Cancer Patients: Focus on Hispanics. Cancers (Basel) 2023; 15:626. [PMID: 36765585 PMCID: PMC9913516 DOI: 10.3390/cancers15030626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Cancer is a public health concern and causes more than 8 million deaths annually. Cancer triggers include population growth, aging, and variations in the prevalence and distribution of the critical risk factors for cancer. Multiple hallmarks are involved in cancer, including cell proliferation, evading growth suppressors, activating invasion and metastasis, resisting cell death, enabling replicative immortality, reprogramming energy metabolism, and evading immune destruction. Both cancer and dementia are age-related and potentially lethal, impacting survival. With increasing aging populations, cancer and dementia cause a burden on patients, family members, the health care system, and informal/formal caregivers. In the current article, we highlight cancer prevalence with a focus on different ethnic groups, ages, and genders. Our article covers risk factors and genetic causes associated with cancer and types of cancers and comorbidities. We extensively cover the impact of cancer in Hispanics in comparison to that in other ethnic groups. We also discuss the status of caregivers with cancer patients and urgent needs from the state and federal support for caregivers.
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Affiliation(s)
- Jasbir Bisht
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
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26
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Stephen JM, Zoucha R, Cazzell M, Devido J. Cultural care needs of Spanish speaking parents with limited English proficiency whose children are hospitalized: An ethnonursing study. J Pediatr Nurs 2023; 69:62-70. [PMID: 36669293 DOI: 10.1016/j.pedn.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 08/08/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Parents' inability to speak English proficiently is associated with communication barriers in the care process of their children, social determinants of health, and poor child health outcomes. Research exploring perspectives of Spanish speaking parents with limited English proficiency (SSP-LEP) whose children are hospitalized in the context of culture is lacking in the literature. The purpose of this study was to explore the cultural experiences, values, and beliefs of SSP-LEP, of Mexican origin, whose children were hospitalized and to understand nurses' roles in providing culturally congruent care. DESIGN AND METHODS Leininger's qualitative, ethnonursing method was used for this study. The Theory of Culture Care Diversity and Universality provided a guiding framework. Eleven SSP-LEP, of Mexican origin, participated in interviews conducted in-person and via Zoom. Data was analyzed using Leininger's four phases of qualitative analysis. RESULTS Three themes emerged: 1. role of the mother as an ever-present manager of care for the hospitalized child and family, 2. parents' difficult, fearful, stressful, and unknowing experiences in the presence of a language barrier, and 3. expected nursing care that was kind, respectful, compassionate, and attentive. CONCLUSIONS Lack of knowledge creates hardships for parents who desire to be involved, informed caregivers. Communication in Spanish language is integral to parents' understanding and expected nursing care. SSP-LEP may have negative feelings; yet describe a positive care experience. PRACTICE IMPLICATIONS Culturally congruent care should incorporate language services for information sharing that facilitates parent participation and decision-making; be kind, respectful, compassionate, and attentive; and promote maternal role maintenance.
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Affiliation(s)
| | - Rick Zoucha
- Advanced Role and PhD Programs, Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA.
| | - Mary Cazzell
- Nursing Research and Evidence-Based Practice, Cook Children's Medical Center, 801 Seventh Avenue, Fort Worth, TX 76104, USA.
| | - Jessica Devido
- Duquesne University, 600 Forbes Avenue, 519 Fisher Hall, Pittsburgh, PA 15202, USA.
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27
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Zamor RL, Vaughn LM, McCann E, Sanchez L, Page EM, Mahabee-Gittens EM. Perceptions and experiences of Latinx parents with language barriers in a pediatric emergency department: a qualitative study. BMC Health Serv Res 2022; 22:1463. [PMID: 36457015 PMCID: PMC9717444 DOI: 10.1186/s12913-022-08839-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/01/2021] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prior research has shown disparities exist among Latinx children who require treatment for respiratory illnesses within the pediatric emergency department (PED). Limited data exist regarding Latinx families' experiences on the care they received at PEDs within non-traditional destination areas (NDA). Their experiences can identify areas of improvement to potentially reduce healthcare disparities among pediatric patients within this population. The purpose of this qualitative study was to explore the lived experiences of Latinx families with low English proficiency in the PED with a NDA. The broader purpose was to identify areas of improvement for reducing health care disparities among Latinx families. METHODS We used qualitative methods to analyze semi-structured interviews among Latinx families who presented to the PED with their 0-2 year-old child for a respiratory illness from May 2019 through January 2020. All participants had low English proficiency and requested a Spanish interpreter during registration. All interviews were transcribed and reviewed using thematic analysis based on a phenomenology framework. RESULTS Interviews were conducted with 16 Latinx parents. Thematic analysis revealed four major themes: (1) Uncertainty - Families expressed uncertainty regarding how to care for a child with distressing symptoms, (2) Communication - Families favored in-person interpreters which enhanced communication and allowed families to feel more informed, (3) System Burden - Families reported that the unfamiliarity with the US health system and lack of resources are additional burdens, and (4) Emotional Support - The emergency department visits garnered confidence and reassurance for families. CONCLUSIONS Our study identified four major themes among Latinx families within a PED of a NDA. Potential areas of interventions should focus on supporting access to an interpreter, improving information delivery, and enhancing education on community resources for families with low English proficiency.
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Affiliation(s)
- Ronine L. Zamor
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA ,grid.189967.80000 0001 0941 6502Present Address: Division of Emergency Medicine, Children’s Healthcare of Atlanta, Emory University, 1547 Clifton Road, NE 2nd Floor, Atlanta, GA 30322 USA
| | - Lisa M. Vaughn
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
| | - Erin McCann
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Luisanna Sanchez
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Erica M. Page
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - E. Melinda Mahabee-Gittens
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
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28
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Takirambudde S, Ruffolo LI, Wakeman DS, Dale BS, Arca MJ, Wilson NA. Social Determinants of Health are Associated With Postoperative Outcomes in Children With Complicated Appendicitis. J Surg Res 2022; 279:692-701. [PMID: 35940047 DOI: 10.1016/j.jss.2022.06.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/01/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Socioeconomic disadvantage has been associated with increased complicated appendicitis rates. Our purpose was to analyze the complex interactions between social determinants of health (SDOH) and postoperative outcomes in pediatric appendicitis. MATERIALS AND METHODS Children who underwent appendectomy at our institution (1/2015-12/2020) were retrospectively reviewed. We used home addresses to determine composite measures of neighborhood/area-level socioeconomic advantage (Area Deprivation Index [ADI] and Social Deprivation Index [SDI]), and other area-level indicators. We created a novel, composite outcome score computed as a weighted average of eight outcome measures. Feature selection and exploratory factor analysis were used to create a multivariate model predictive of outcomes. RESULTS Of 1117 children with appendicitis, 20.59% had complicated (perforated) appendicitis. Factor analysis identified two multivariate latent factors; Factor 1 contained SDI, ADI, and % unemployed in the population, and Factor 2 contained % Hispanic and % foreign-born in the population. Low Factor 2 scores (communities with more Hispanic/foreign-born residents) were associated with increased length of stay, more frequent postoperative percutaneous drainage, and increased postoperative imaging. CONCLUSIONS Interactions between SDOH and pediatric surgical care go beyond the individual patient and suggest that vulnerable populations are exposed to contextual conditions that may impact outcomes. Specifically, neighborhood-level factors, including the prevalence of Hispanic ethnicity and foreign-born individuals, are associated with outcomes in pediatric patients with complicated appendicitis. Reducing disparities in complicated appendicitis outcomes may involve addressing neighborhood-level SDOH through strategic reallocation of healthcare resources and developing targeted interventions to improve access to pediatric surgical care in underserved communities.
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Affiliation(s)
- Sanyu Takirambudde
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Luis I Ruffolo
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Derek S Wakeman
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Benjamin S Dale
- Department of Biomedical Engineering, University of Rochester, Rochester, New York
| | - Marjorie J Arca
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Nicole A Wilson
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York; Department of Biomedical Engineering, University of Rochester, Rochester, New York.
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29
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Alramadhan MM, Al Khatib HS, Murphy JR, Tsao K, Chang ML. Using Artificial Neural Networks to Predict Intra-Abdominal Abscess Risk Post-Appendectomy. ANNALS OF SURGERY OPEN 2022; 3:e168. [PMID: 37601615 PMCID: PMC10431380 DOI: 10.1097/as9.0000000000000168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/27/2021] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To determine if artificial neural networks (ANN) could predict the risk of intra-abdominal abscess (IAA) development post-appendectomy. Background IAA formation occurs in 13.6% to 14.6% of appendicitis cases with "complicated" appendicitis as the most common cause of IAA. There remains inconsistency in describing the severity of appendicitis with variation in treatment with respect to perforated appendicitis. Methods Two "reproducible" ANN with different architectures were developed on demographic, clinical, and surgical information from a retrospective surgical dataset of 1574 patients less than 19 years old classified as either negative (n = 1,328) or positive (n = 246) for IAA post-appendectomy for appendicitis. Of 34 independent variables initially, 12 variables with the highest influence on the outcome selected for the final dataset for ANN model training and testing. Results A total of 1574 patients were used for training and test sets (80%/20% split). Model 1 achieved accuracy of 89.84%, sensitivity of 70%, and specificity of 93.61% on the test set. Model 2 achieved accuracy of 84.13%, sensitivity of 81.63%, and specificity of 84.6%. Conclusions ANN applied to selected variables can accurately predict patients who will have IAA post-appendectomy. Our reproducible and explainable ANNs potentially represent a state-of-the-art method for optimizing post-appendectomy care.
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Affiliation(s)
- Morouge M. Alramadhan
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
| | - Hassan S. Al Khatib
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
| | - James R. Murphy
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
| | - KuoJen Tsao
- Division of General and Thoracic Pediatric Surgery, Department of Pediatric Surgery, UTHealth Houston McGovern Medical School, Houston, TX
| | - Michael L. Chang
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
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30
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Payson A, Pulido A, San Martin S, Garlesky C, Garcia E, Reyes C, Reyes M, Leyenaar J. Inequities in Pain Assessment and Care of Hospitalized Children With Limited English Proficiency. Hosp Pediatr 2022; 12:561-568. [PMID: 35499379 DOI: 10.1542/hpeds.2021-006445] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To examine inequities in pain assessment and management of hospitalized children with limited English proficiency (LEP) as assessed by (1) self-reported pain prevalence and intensity, and (2) nurse-documented pain assessments and analgesia. METHODS A cross-sectional survey of hospitalized children and parent proxies examined preferred language and pain prevalence, intensity, and etiology; subsequent electronic medical record chart review examined demographics, nurse-documented pain scores, and analgesia prescribed for children aged ≤21 years at a tertiary care children's hospital. The primary outcome was a difference of ≥3 points between self-reported and nurse-documented worst pain scores. Descriptive statistics, Fisher's exact tests, and multivariable logistic regression were used to identify differences in outcomes between children with and without LEP. RESULTS A total of 155 patients (50% children and 50% parental proxies) were interviewed (96% response rate). Of those, 60% (n = 93) reported pain in the previous 24 hours, most frequently because of acute illnesses. Of patients reporting pain, 65% (n = 60) reported a worst pain score of ≥3 points higher than nurse-documented scores; this discrepancy affected more patients with LEP (82%, n = 27) than English-proficient patients (55%, n = 33) (P = .01) with an adjusted odds ratio of 3.2 (95% confidence interval: 1.13-10.31). Patients with LEP were also less likely than English-proficient patients to receive medications at the time of their worst pain (60% vs 82%, P = .03), particularly opioid analgesia (9% vs 22%, P = .04). CONCLUSIONS Children with LEP were more likely to self-report pain scores that exceeded nurse-documented scores and received less medications, particularly opiates. This population may be particularly vulnerable to underassessment and inadequate management of pain.
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Affiliation(s)
- Alison Payson
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Anamaria Pulido
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | | | - Cindy Garlesky
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Erileen Garcia
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Clara Reyes
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Mario Reyes
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - JoAnna Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Lowe JT, Monteiro KA, Zonfrillo MR. Disparities in Pediatric Emergency Department Length of Stay and Utilization Associated With Primary Language. Pediatr Emerg Care 2022; 38:e1192-e1197. [PMID: 34570076 DOI: 10.1097/pec.0000000000002545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the association between primary language and length of stay (LOS) in the pediatric emergency department (ED) within the context of known disparities impacting healthcare experiences and outcomes for patients with language barriers. METHODS We conducted a retrospective cohort study of consecutive encounters of patients presenting to, and discharged from, an urban pediatric ED from May 2015 through April 2018. Encounters were grouped into English primary language (EPL), Spanish (SPL), and other (OPL). Mean LOS comparisons were stratified by Emergency Severity Index (ESI). Bivariate and multivariate analyses were used to examine the relationship between LOS and variables, including age, sex, race/ethnicity, insurance, and time of presentation. RESULTS A total of 139,163 encounters were included. A higher proportion of SPL and OPL encounters were characterized as lower ESI acuity compared with EPL. Significantly longer LOS for SPL and OPL encounters was observed in the 2 lower acuity strata. The ESI 4-5 stratum demonstrated the greatest LOS disparity between EPL, SPL, and OPL (94 vs 103 vs 103 minutes, respectively, P < 0.001). In the highest acuity stratum, ESI 1-2, there was a nonsignificant trend toward longer LOS among EPL encounters (P = 0.08). The multivariate model accounted for 24% of LOS variance, but effect sizes were small for all variables except for ESI and age. CONCLUSIONS Patients with Spanish or other non-EPL who were triaged to lower acuity ESI levels experienced longer LOS in the pediatric ED than English-speaking counterparts. They also used the ED more frequently for low acuity issues, possibly reflecting disparities in access to primary care.
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Affiliation(s)
| | | | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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32
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Quinn KM, Huang KX, Jones RH, Cina RA. Hypoxic respiratory failure in acute appendicitis: A bronchoperitoneal fistula as the presenting symptom of appendicitis in the setting of pediatric COVID-19. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022; 79:102223. [PMID: 35223426 PMCID: PMC8860748 DOI: 10.1016/j.epsc.2022.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 12/05/2022] Open
Abstract
Symptomatic COVID-19 less frequently affects the pediatric population and is often associated with atypical presenting symptoms. Here we describe a nine-year-old patient who presented with acute hypoxic respiratory failure and was found to have perforated appendicitis, intra-abdominal abscess, and bronchoperitoneal fistula. The rapid progression of this pathology, complex critical care decision making, and ultimate surgical management has not been previously described. Documenting this patient's clinical course and effective treatments may serve to inform and guide the medical community and pediatric care providers as the world continues to combat the COVID-19 pandemic.
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Affiliation(s)
- Kristen M Quinn
- Department of Surgery, Medical University of South Carolina, USA
| | - Kevin X Huang
- Department of Surgery, Medical University of South Carolina, USA
| | - Richard H Jones
- Department of Radiology, Medical University of South Carolina Shawn Jenkins Children's Hospital, USA
| | - Robert A Cina
- Department of Pediatric Surgery, Medical University of South Carolina Shawn Jenkins Children's Hospital, USA
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33
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Mateo CM, Johnston PR, Wilkinson RB, Tennermann N, Grice AW, Chuersanga G, Ward VL. Sociodemographic and Appointment Factors Affecting Missed Opportunities to Provide Neonatal Ultrasound Imaging. J Am Coll Radiol 2022; 19:112-121. [PMID: 35033298 DOI: 10.1016/j.jacr.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/03/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to assess disparities in outpatient imaging missed care opportunities (IMCOs) for neonatal ultrasound by sociodemographic and appointment factors at a large urban pediatric hospital. METHODS A retrospective review was performed among patients aged 0 to 28 days receiving one or more outpatient appointments for head, hip, renal, or spine ultrasound at the main hospital or satellite sites from 2008 to 2018. An IMCO was defined as a missed ultrasound or cancellation <24 hours in advance. Population-average correlated logistic regression modeling estimated the odds of IMCOs for six sociodemographic (age, sex, race/ethnicity, language, insurance, and region of residence) and seven appointment (type of ultrasound, time, day, season, site, year, and distance to appointment) factors. The primary analysis included unknown values as a separate category, and the secondary analysis used multiple imputation to impute genuine categories from unknown variables. RESULTS The data set comprised 5,474 patients totaling 6,803 ultrasound appointments. IMCOs accounted for 4.4% of appointments. IMCOs were more likely for Black (odds ratio [OR], 3.31; P < .001) and other-race neonates (OR, 2.66; P < .001) and for patients with public insurance (OR, 1.78; P = .002). IMCOs were more likely for appointments at the main hospital compared with satellites (P < .001), during work hours (P = .021), and on weekends (P < .001). Statistical significance for primary and secondary analyses was quantitatively similar and qualitatively identical. CONCLUSIONS Marginalized racial groups and those with public insurance had a higher rate of IMCOs in neonatal ultrasound. This likely represents structural inequities faced by these communities, and more research is needed to identify interventions to address these inequities in care delivery for vulnerable neonatal populations.
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Affiliation(s)
- Camila M Mateo
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Ronald B Wilkinson
- Information Services Department, Boston Children's Hospital, Boston, Massachusetts
| | - Nicole Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Amanda W Grice
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Geeranan Chuersanga
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts; Senior Vice-President, Chief Equity and Inclusion Officer, and Director, Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts.
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Advanced imaging of disease unrelated to the coronavirus disease 2019 (COVID-19) during the pandemic: effect of patient demographics in a pediatric emergency department. Pediatr Radiol 2022; 52:1756-1764. [PMID: 35441838 PMCID: PMC9018967 DOI: 10.1007/s00247-022-05357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/03/2021] [Revised: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disproportionately affected children from underrepresented minorities and marginalized populations, but little is understood regarding the pandemic's effect on non-COVID-19-related illnesses. OBJECTIVE To examine the effect of the COVID-19 pandemic and related stay-at-home orders on pediatric emergency department (ED) imaging of non-COVID-19-related diseases across patient demographic groups. MATERIALS AND METHODS We retrospectively reviewed radiology reports from advanced imaging (US, CT, MRI and fluoroscopy) on children in the ED during the month of April for the years 2017, 2018, 2019 and 2020, excluding imaging for respiratory illness and trauma. We used imaging results and the electronic medical record to identify children with positive diagnoses on advanced imaging, and whether these children were admitted to the hospital. Demographic variables included age, gender, race/ethnicity and insurance type. We used multivariable Poisson regression models to report rate ratio (RR) and binomial logistic regression models to report odds ratio (OR) with 95% confidence interval (CI). RESULTS We included 1,418 ED encounters for analysis. Compared to pre-2020, fewer children underwent ED imaging in April 2020 (RR 0.63, 95% CI 0.52, 0.76). The odds of positive imaging results increased (OR 2.18, 95% CI 1.59, 3.00) overall, and for all racial/ethnic groups except Hispanic patients (OR 0.83, 95% CI 0.34, 2.03). No differences occurred in admission rates for positive imaging results in 2020 compared to pre-2020. CONCLUSION In April 2020 compared to pre-2020, there were decreased imaging and increased positivity rates for imaging for non-respiratory and non-trauma ED visits. COVID-19 stay-at-home advisories might have resulted in triaging for urgent health care by families or referring clinicians during this month of the pandemic.
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Nageswaran S, Ellis MB, Beveridge MS. Communication Challenges Faced by Spanish-Speaking Caregivers of Children with Medical Complexity: a Qualitative Study. J Racial Ethn Health Disparities 2022; 9:2218-2226. [PMID: 34595676 PMCID: PMC8483426 DOI: 10.1007/s40615-021-01161-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Communication between caregivers and healthcare providers is important in the delivery of high-quality healthcare for children with medical complexity (CMC). Hispanic children face many challenges in access to healthcare services. Our objective was to describe the communication challenges faced by Spanish-speaking parents with limited English proficiency (SSP-LEP). METHODS This was a qualitative study of 70 children of Spanish-speaking caregivers, enrolled in a complex care program of a tertiary care children's hospital in North Carolina. Secondary source data were abstracted logs of care coordination tasks maintained by the program's two bilingual care coordinators for a median observation period of 45 months, and complemented by data from care coordinator interviews. Data were entered and coded in ATLAS.ti. Using thematic content analysis and an iterative process, we identified recurrent themes related to communication challenges of Spanish-speaking caregivers. RESULTS Median age of children was 5 years; 51% were girls; 97% had Medicaid; and 3% were uninsured. Seven children died during the observation period. Three major themes were identified as follows: (1) caregivers faced many communication challenges primarily because of language barrier. (2) Multiple factors at caregiver, provider, and system levels, in addition to language barrier, contributed to communication challenges. (3) Communication challenges had serious consequences for CMC. These consequences were lessened by bilingual coordinators. CONCLUSION SSP-LEP face unique communication challenges resulting in negative impact on the healthcare of their CMC. Bilingual coordinators can help improve communication between SSP-LEP and their healthcare providers. Interventions to address communication challenges of Spanish-speaking caregivers are warranted.
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Affiliation(s)
- Savithri Nageswaran
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | | | - Mark S Beveridge
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
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Tam I, Gist L, Patel A, Fisher E, Rhee KE. The Parent's Perspective: A Focus Group Study on Spanish Interpreter Services for Hospitalized Children. Acad Pediatr 2022; 22:98-106. [PMID: 34273559 DOI: 10.1016/j.acap.2021.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 08/19/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The US Census confirms a rise in Spanish-speakers, many of whom have limited English proficiency (LEP) and require interpreters. Parent perceptions of interpreter services throughout hospitalization are unknown. OBJECTIVE To explore Spanish-speaking LEP parents' views regarding roles of interpreters and providers (attending, resident, or nurse) during a hospital encounter, optimal modalities of interpretation, and barriers to services. METHODS Spanish-speaking LEP parents of children discharged from the hospital medicine service participated in focus groups. Sessions were audio-recorded and transcribed in Spanish, translated into English, and verified for translation accuracy. Qualitative methods were used for thematic analysis. RESULTS Four sessions (n = 23 participants representing 15 families) were held. Parents felt the interpreter's primary role was to act as a conduit for word-for-word interpretation. They desired kind and trustworthy interpreters with medical knowledge. They saw providers as leaders of the encounter who should allot enough time for interpretation, not use Spanish unless they were fluent, and give frequent medical updates. In-person interpreters were preferred over telephone and video for their ability to convey body language and build relationships. Barriers to requesting interpreters included embarrassment and inability to directly request services, which resulted in using family members as interpreters. On family-centered rounds, parents preferred professional interpreters over bilingual providers. CONCLUSIONS Modifications are required to improve interpreter services to meet the needs of LEP families. Parents emphasized in-person interpreters' social skills, frequent provider updates, and additional navigation support as essential components of effective care. Next steps include implementing guidelines and interventions to optimize interpreter services.
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Affiliation(s)
- Ivy Tam
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee); Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine (I Tam), Bronx, NY..
| | - Lauren Gist
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
| | - Aarti Patel
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
| | - Erin Fisher
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
| | - Kyung E Rhee
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego (I Tam, L Gist, A Patel, E Fisher, and KE Rhee)
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Hartford EA, Carlin K, Rutman LE, Lion KC. Changes in Rates and Modality of Interpreter Use for Pediatric Emergency Department Patients in the COVID-19 Era. Jt Comm J Qual Patient Saf 2021; 48:139-146. [PMID: 35058161 PMCID: PMC8590502 DOI: 10.1016/j.jcjq.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/17/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
Background As the COVID-19 pandemic continues, health care systems around the world have changed care delivery in significant ways. Racial and ethnic disparities have emerged for COVID-19 infection rates, morbidity, and mortality. Inequities in care and underutilization of interpretation for patients who use a language other than English (LOE) for care existed prior to this era. This study sought to evaluate interpreter use in a pediatric emergency department (ED) as changes associated with COVID-19 were implemented. Methods ED records were reviewed from December 1, 2019, to July 31, 2020. Patients were classified as having LOE if they preferred a language other than English and consented to interpretation. Statistical process control was used to analyze changes in interpreter use over time, relative to the onset of COVID-19–related operational changes. Beginning March 1, 2020, in-person interpreters were no longer available and staff were encouraged to communicate from outside the patient room when possible; this change served as the exposure of interest. Interpreter use for LOE patients, overall and by triage acuity level, was the study outcome. Results A total of 26,787 encounters were included. The weekly mean proportion of encounters that used interpretation for patients with LOE increased from 59% to 73% after the onset of COVID-19. This increase met criteria for special cause variation. Interpretation modality changed to being mostly by phone from previously by video or in-person. Conclusion Operational changes in the ED related to COVID-19 were associated with increased interpreter use. Possible explanations include lower patient volumes or changes in model of care that encouraged interpreter use by a variety of modalities.
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Miller JJ, Serwint JR, Boss RD. Clinician-family relationships may impact neonatal intensive care: clinicians' perspectives. J Perinatol 2021; 41:2208-2216. [PMID: 34091604 PMCID: PMC8178652 DOI: 10.1038/s41372-021-01120-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 02/03/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Collaborative clinician-family relationships are necessary for the delivery of successful patient- and family-centered care (PFCC) in the NICU. Challenging clinician-family relationships may undermine such collaboration and the potential impacts on patient care are unknown. STUDY DESIGN Consistent caregivers were surveyed to describe their relationships and collaboration with families of infants hospitalized ≥ 28 days. Medical record review collected infant and family characteristics hypothesized to impact relationships. Mixed methods analysis was performed. RESULTS Clinicians completed 243 surveys representing 77 families. Clinicians reported low collaboration with families who were not at the bedside and/or did not speak English. Clinicians perceived most clinician-family relationships impact the infant's hospital course. Negative impacts included communication challenges, mistrust or frustration with the team and disruptions to patient care. CONCLUSION This study identifies features of clinician-family relationships that may negatively impact an infant's NICU stay. Targeting supports for these families is necessary to achieve effective PFCC.
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Goyal MK, Chamberlain JM, Webb M, Grundmeier RW, Johnson TJ, Lorch SA, Zorc JJ, Alessandrini E, Bajaj L, Cook L, Alpern ER. Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Acad Emerg Med 2021; 28:949-956. [PMID: 32991770 DOI: 10.1111/acem.14142] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Appendicitis is the most common surgical condition in pediatric emergency department (ED) patients. Prompt diagnosis can reduce morbidity, including appendiceal perforation. The goal of this study was to measure racial/ethnic differences in rates of 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s). METHODS This was a 3-year multicenter (seven EDs) retrospective cohort study of children diagnosed with appendicitis using the Pediatric Emergency Care Applied Research Network Registry. Delayed diagnosis was defined as having at least one prior ED visit within 7 days preceding appendicitis diagnosis. We performed multivariable logistic regression to measure associations of race/ethnicity (non-Hispanic [NH]-white, NH-Black, Hispanic, other) with 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s). RESULTS Of 7,298 patients with appendicitis and documented race/ethnicity, 2,567 (35.2%) had appendiceal perforation. In comparison to NH-whites, NH-Black children had higher likelihood of perforation (36.5% vs. 34.9%; adjusted odds ratio [aOR] = 1.21 [95% confidence interval {CI} = 1.01 to 1.45]). A total of 206 (2.8%) had a delayed diagnosis of appendicitis. NH-Black children were more likely to have delayed diagnoses (4.7% vs. 2.0%; aOR = 1.81 [95% CI = 1.09 to 2.98]). Eighty-nine (43.2%) patients with delayed diagnosis had abdominal imaging during their prior visits. In comparison to NH-whites, NH-Black children were less likely to undergo any imaging (28.2% vs. 46.2%; aOR = 0.41 [95% CI = 0.18 to 0.96]) or definitive imaging (e.g., ultrasound/computed tomography/magnetic resonance imaging; 10.3% vs. 35.9%; aOR = 0.15 [95% CI = 0.05 to 0.50]) during prior visits. CONCLUSIONS In this multicenter cohort, there were racial disparities in appendiceal perforation. There were also racial disparities in rates of delayed diagnosis of appendicitis and diagnostic imaging during prior ED visits. These disparities in diagnostic imaging may lead to delays in appendicitis diagnosis and, thus, may contribute to higher perforation rates demonstrated among minority children.
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Affiliation(s)
- Monika K. Goyal
- Departments of Pediatrics & Emergency Medicine Children's National HospitalThe George Washington University Washington DC USA
| | - James M. Chamberlain
- Departments of Pediatrics & Emergency Medicine Children's National HospitalThe George Washington University Washington DC USA
| | - Michael Webb
- Department of Pediatrics University of Utah Salt Lake City UT USA
| | - Robert W. Grundmeier
- Department of Pediatrics Children's Hospital of PhiladelphiaUniversity of Pennsylvania Philadelphia PA USA
| | | | - Scott A. Lorch
- Department of Pediatrics Children's Hospital of PhiladelphiaUniversity of Pennsylvania Philadelphia PA USA
| | - Joseph J. Zorc
- Department of Pediatrics Children's Hospital of PhiladelphiaUniversity of Pennsylvania Philadelphia PA USA
| | - Evaline Alessandrini
- James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center Cincinnati OH USA
| | - Lalit Bajaj
- Department of Pediatrics University of ColoradoChildren's Hospital Colorado Aurora CO USA
| | - Lawrence Cook
- Department of Pediatrics University of Utah Salt Lake City UT USA
| | - Elizabeth R. Alpern
- Department of Pediatrics Ann & Robert H. Lurie Children's HospitalNorthwestern University Feinberg School of Medicine Chicago IL USA
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Congdon M, Schnell SA, Londoño Gentile T, Faerber JA, Bonafide CP, Blackstone MM, Johnson TJ. Impact of patient race/ethnicity on emergency department management of pediatric gastroenteritis in the setting of a clinical pathway. Acad Emerg Med 2021; 28:1035-1042. [PMID: 33745207 DOI: 10.1111/acem.14255] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/11/2020] [Revised: 01/01/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute gastroenteritis (AGE) is a common pediatric diagnosis in emergency medicine, accounting for 1.7 million visits annually. Little is known about racial/ethnic differences in care in the setting of standardized care models. METHODS We used quality improvement data for children 6 months to 18 years presenting to a large, urban pediatric emergency department (ED) treated via a clinical pathway for AGE/dehydration between 2011 and 2018. Race/ethnicity was evaluated as a single variable (non-Hispanic [NH]-White, NH-Black, Hispanic, and NH-other) related to ondansetron and intravenous fluid (IVF) administration, ED length of stay (LOS), hospital admission, and ED revisits using multivariable regression. RESULTS Of 30,849 ED visits for AGE/dehydration, 18.0% were NH-White, 57.2% NH-Black, 12.5% Hispanic, and 12.3% NH-other. Multivariable mixed-effects generalized linear regression controlling for age, sex, triage acuity, payer, and language revealed that, compared to NH-White patients, NH-other patients were more likely to receive ondansetron (adjusted odds ratio [95% CI] = 1.30 [1.17 to 1.43]). NH-Black, Hispanic, and NH-other patients were significantly less likely to receive IVF (0.59 [0.53 to 0.65]; 0.74 [0.64 to 0.84]; 0.74 [0.65 to 0.85]) or be admitted to the hospital (0.54 [0.45 to 0.64]; 0.62 [0.49 to 0.78]; 0.76 [0.61 to 0.94]), respectively. NH-Black and Hispanic patients had shorter LOS (median = 245 minutes for NH-White, 176 NH-Black, 199 Hispanic, and 203 NH-other patients) without significant differences in ED revisits. CONCLUSIONS Despite the presence of a clinical pathway to guide care, NH-Black, Hispanic, and NH-other children presenting to the ED with AGE/dehydration were less likely to receive IVF or hospital admission and had shorter LOS compared to NH-White counterparts. There was no difference in patient revisits, which suggests discretionary overtreatment of NH-White patients, even with clinical guidelines in place. Further research is needed to understand the drivers of differences in care to develop interventions promoting equity in pediatric emergency care.
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Affiliation(s)
- Morgan Congdon
- Department of General Pediatrics Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - Stephanie A. Schnell
- Department of Neonatology Children’s Hospital of Los Angeles Los Angeles California USA
| | - Tatiana Londoño Gentile
- Department of General Pediatrics Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - Jennifer A. Faerber
- Department of Biomedical and Health Informatics Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - Christopher P. Bonafide
- Department of General Pediatrics Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - Mercedes M. Blackstone
- Department of Emergency Medicine Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - Tiffani J. Johnson
- Department of Emergency Medicine University of California, Davis Sacramento California USA
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Kharbanda AB. Improving Appendicitis Care for All Patients. JAMA Netw Open 2021; 4:e2124523. [PMID: 34463750 DOI: 10.1001/jamanetworkopen.2021.24523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis
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Stokes SC, Jackson JE, Beres AL. Impact of Limited English Proficiency on Definitive Care in Pediatric Appendicitis. J Surg Res 2021; 267:284-292. [PMID: 34171564 DOI: 10.1016/j.jss.2021.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/29/2020] [Revised: 04/02/2021] [Accepted: 05/07/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Limited English proficiency (LEP) is associated with decreased access to healthcare. We hypothesized that LEP children with appendicitis would experience more delays in care than EP children. METHODS Retrospective review of patients <18 y presenting to a tertiary pediatric hospital July 2014-July 2019 with appendicitis. LEP patients were compared to EP patients. The primary outcome was appendiceal perforation. Secondary outcomes included prior pediatrician or emergency department (ED) visits without definitive management, duration of symptoms, length of stay (LOS), initial operative or non-operative management, time from presentation to operation and return to the ED within 30 d. Multivariable regression was performed to evaluate LEP as a predictor of study outcomes. RESULTS A total of 893 patients with appendicitis were identified, 15.6% (n = 140) had LEP. On multivariate regression LEP was not a significant predictor of appendiceal perforation (AOR 1.20, 95% CI 0.79, 1.80, P = 0.390). LEP was a significant predictor of a prior ED or pediatrician visit without definitive management (AOR 2.05, 95 % CI 1.05, 3.98, P= 0.034) and longer LOS (Coefficient 1.01, 95% CI 0.41, 1.61, P= 0.001). LEP was associated with a minimal increase in duration of pain prior to presentation that was not clinically significant and was not associated with initial operative or non-operative management or a significantly longer time between presentation and operation. CONCLUSIONS LEP children did not experience higher rates of appendiceal perforation at our institution, but were more frequently initially evaluated by a pediatrician or at an ED and discharged without definitive management and had longer LOS.
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Affiliation(s)
- Sarah C Stokes
- Department of Surgery, University of California-Davis, Sacramento, California.
| | - Jordan E Jackson
- Department of Surgery, University of California-Davis, Sacramento, California
| | - Alana L Beres
- Department of Surgery, University of California-Davis, Sacramento, California
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Mitigating disparity in children with acute appendicitis: Impact of patient-driven protocols. J Pediatr Surg 2021; 56:663-667. [PMID: 33183744 DOI: 10.1016/j.jpedsurg.2020.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 04/27/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Previous reports in the literature demonstrate racial and ethnic disparities for children diagnosed with acute appendicitis, with minorities experiencing worse outcomes. At our institution, we have developed an evidence based patient driven protocol for children following laparoscopic appendectomy. However, the influence of such protocol on mitigating racial and ethnic disparities in outcomes remains unknown. The purpose of our study is to assess the impact of our protocol by evaluating the influence of race and ethnicity on surgical outcomes among children treated for acute appendicitis. MATERIAL AND METHODS A retrospective review of prospectively collected data was conducted. Children undergoing a laparoscopic appendectomy at our freestanding children's hospital between December 2015 and July 2017 were included. Demographic data, post-operative length of stay, same day discharge rates and hospital readmission rates were abstracted from patient medical records. Patients were classified by their race and ethnic background. Comparative analysis was performed in STATA with a p value <.05 determined as significant. RESULTS A total of 786 children were included, with the majority being either White (70%, n = 547), Black (8%, n = 62) or Hispanic (17%, n = 133); 569 patients (72%) were found to have non-perforated appendicitis. There was no statistically significant difference in the rates of same day discharge among White, Black or Hispanic children respectively (88% vs. 77% vs. 86%, p = .126). Of the 217 children with perforated appendicitis, Hispanic children had increased rates of perforation (41%, n = 55) compared to White and Black children respectively (23%, n = 128 and 29%, n = 18, p = .001). However, average post-operative length of stay were similar among White, Black and Hispanic children (96 h vs. 95 h vs. 98 h, p = .015). On multivariate analysis, the only significant risk factor for an elevated post-operative length of stay was the presence of a perforation. CONCLUSION Our evidence based patient driven protocol effectively mitigates racial and ethnic disparities found in children with acute appendicitis. Further prospective investigation into the role of such patient-driven protocols to mitigate healthcare disparities is warranted. LEVELS OF EVIDENCE Therapeutic study; Level 3.
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Patient Race/Ethnicity and Diagnostic Imaging Utilization in the Emergency Department: A Systematic Review. J Am Coll Radiol 2020; 18:795-808. [PMID: 33385337 DOI: 10.1016/j.jacr.2020.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE Diagnostic imaging often is a critical contributor to clinical decision making in the emergency department (ED). Racial and ethnic disparities are widely reported in many aspects of health care, and several recent studies have reported a link between patient race/ethnicity and receipt of imaging in the ED. METHODS The authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching three databases (PubMed, Embase, and the Cochrane Library) through July 2020 using keywords related to diagnostic imaging, race/ethnicity, and the ED setting, including both adult and pediatric populations and excluding studies that did not control for the important confounders of disease severity and insurance status. RESULTS The search strategy identified 7,313 articles, of which 5,668 underwent title and abstract screening and 238 full-text review, leaving 42 articles meeting the inclusion criteria. Studies were predominately conducted in the United States (41), split between adult (13) and pediatric (17) populations or both (12), and spread across a variety of topics, mostly focusing on specific anatomic regions or disease processes. Most studies (30 of 42 [71.4%]) reported an association between Black, African American, Hispanic, or nonwhite race/ethnicity and decreased receipt of imaging. CONCLUSIONS Despite heterogeneity among studies, patient race/ethnicity is linked with receipt of diagnostic imaging in the ED. The strength and directionality of this association may differ by specific subpopulation and disease process, and more efforts to understand potential underlying factors are needed.
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Patel AT, Lee BR, Donegan R, Humiston SG. Length of Stay for Patients With Limited English Proficiency in Pediatric Urgent Care. Clin Pediatr (Phila) 2020; 59:421-428. [PMID: 31994413 DOI: 10.1177/0009922820902439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022]
Abstract
This retrospective chart review compared the length of stay (LOS) of families with limited English proficiency (LEP) versus English-speaking families seen in 3 pediatric urgent care centers (PUCCs). Visits were included for patients aged 2 months to 17 years seen between January 1, 2016, and December 31, 2016, with 1 of 5 primary diagnoses. For each LEP encounter, we randomly selected 3 English-speaking encounters within the same PUCC and diagnosis class. We compared overall LOS between LEP and English-speaking encounters. Of our entire sample, 184 (1.03%) were LEP encounters, of which 145 (78.8%) preferred Spanish. Comparing the LEP visits to 552 matched English-speaking visits, we found a significant difference in average LOS (LEP 85.5 minutes; English-speaking 76.4 minutes) and in prescriptions provided (P = .005) but not in triaged acuity nor number of medications administered, laboratory or radiological studies, or suction treatments. This study serves as a starting point to better care for patients/families with LEP in PUCCs.
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Stephen JM, Zoucha R. Spanish Speaking, Limited English Proficient Parents whose Children are Hospitalized: An Integrative Review. J Pediatr Nurs 2020; 52:30-40. [PMID: 32163844 DOI: 10.1016/j.pedn.2020.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 10/30/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
PROBLEM Children of non-English speakers are at risk for health disparities. Little is known about the experiences of Spanish speaking parents with limited English proficiency (LEP) whose children are hospitalized. The purposes of this integrative review were to explore what is known and to identify gaps in the literature about the experiences of Spanish speaking parents with LEP whose children are hospitalized. ELIGIBILITY CRITERIA Whittemore and Knafl's (2005) integrative review method guided the process. Studies addressed Spanish speaking parents of hospitalized children in the United States. SAMPLE A final sample consisted of 36 quantitative and qualitative research studies published from 1994 to 2018; located through a search of CINAHL, Pubmed, and Scopus. RESULTS Language services were inconsistent although mandated by standards and laws. Parents experienced mixed emotions related to care. Emergency departments in large, urban cities were the most common care settings. Differences in care outcomes and safety risks for children of Spanish speaking parents existed; however, findings were inconsistent. Only three of the 36 studies addressed nursing care. CONCLUSIONS Research design and quality varied. Parents valued communication in their language. Nurses are the primary healthcare provider in the hospital setting but few studies explored parents' experiences associated with nursing care. No studies explored parents' experiences with their child's hospitalization in the context of culture. IMPLICATIONS Future research is needed to explore the cultural values, beliefs, and experiences of Spanish speaking parents with LEP and the role of nurses and to inform culturally congruent nursing care, research, and policy.
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Zamor R, Byczkowski T, Zhang Y, Vaughn L, Mahabee-Gittens EM. Language Barriers and the Management of Bronchiolitis in a Pediatric Emergency Department. Acad Pediatr 2020; 20:356-363. [PMID: 31981655 PMCID: PMC7102638 DOI: 10.1016/j.acap.2020.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 10/11/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Language barriers may influence the management of pediatric emergency department (PED) patients who may not align with evidence-based guidelines from the American Academy of Pediatrics. Our objective was to determine if a family's preferred language of Spanish versus English was associated with differences in management of bronchiolitis in the PED. METHODS We conducted a retrospective study of children ≤2 years old diagnosed with bronchiolitis in a PED over a 7-year period. Rates of PED testing, interventions, and disposition among children whose families' preferred language was Spanish were compared to children whose families' preferred language was English. Primary outcomes were frequencies of chest x-ray and bronchodilator orders. Secondary outcomes were diagnostic testing, medication orders, and disposition. Logistic regression was used to calculate adjusted odds ratios after controlling for age, emergency severity index, prior visit, and nesting within attending physicians. RESULTS A total of 13,612 encounters were included. Spanish-speaking families were more likely to have chest x-rays (35.8% vs 26.7%, P < .0001; adjusted odds ratio [aOR] 1.5; 95% confidence interval [CI] 1.2-1.9), complete blood counts (8.2% vs 4.9%, P < .005; aOR 1.7; 95% CI 1.2-2.5), and blood cultures ordered (8.1% vs 5.0%, P < .05; aOR 1.7; 95% CI 1.2-2.4). No other differences in bronchodilators, medication orders, or disposition were found between the 2 groups. CONCLUSIONS Among children diagnosed with bronchiolitis, Spanish-speaking families were more likely to have chest x-rays, complete blood counts, and blood cultures ordered compared to English-speaking families. Further research on how clinical practice guidelines and equity-focused guidelines can impact disparities in diagnostic testing within the PED is warranted.
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Affiliation(s)
- Ronine Zamor
- Department of Emergency Medicine, Cincinnati Children's Hospital and Medical Center (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio.
| | - Terri Byczkowski
- Department of Emergency Medicine, Cincinnati Children's Hospital and Medical Center (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center (Y Zhang), Cincinnati, Ohio
| | - Lisa Vaughn
- Department of Emergency Medicine, Cincinnati Children's Hospital and Medical Center (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio
| | - E Melinda Mahabee-Gittens
- Department of Emergency Medicine, Cincinnati Children's Hospital and Medical Center (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (R Zamor, T Byczkowski, L Vaughn, and EM Mahabee-Gittens), Cincinnati, Ohio
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Owens A, Holroyd BR, McLane P. Patient race, ethnicity, and care in the emergency department: A scoping review. CAN J EMERG MED 2020; 22:245-253. [PMID: 32063258 DOI: 10.1017/cem.2019.458] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Health disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care. METHODS A scoping review was conducted to capture the broad nature of the literature. A database search was conducted in MEDLINE/PubMed, EMBASE, CINAHL Plus, Social Sciences Citation Index, SCOPUS, and JSTOR. Five journals and reference lists of included articles were hand searched. Inclusion and exclusion criteria were defined iteratively to ensure literature captured was relevant to our research question. Data were extracted using predetermined variables, and additional extraction variables were added as familiarity with the literature developed. RESULTS Searching yielded 1,157 citations, reduced to 153 following removal of duplicates, and title and abstract screening. After full-text screening, 83 articles were included. Included articles report that, in EDs, patient race and ethnicity impact analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient subjective experiences. Authors of included studies propose a variety of possible causes for these disparities. CONCLUSIONS Further research on the existence of disparities in care within EDs is warranted to explore the causes behind observed disparities for particular health conditions and population groups in specific contexts.
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Affiliation(s)
| | - Brian R Holroyd
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, University of Alberta Hospital, Edmonton, AB
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB
| | - Patrick McLane
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, University of Alberta Hospital, Edmonton, AB
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB
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Hartford EA, Anderson AP, Klein EJ, Caglar D, Carlin K, Lion KC. The Use and Impact of Professional Interpretation in a Pediatric Emergency Department. Acad Pediatr 2019; 19:956-962. [PMID: 31394260 PMCID: PMC6855248 DOI: 10.1016/j.acap.2019.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 10/08/2018] [Revised: 04/29/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with limited English proficiency (LEP) experience worse health care outcomes compared to English proficient (EP) patients, and professional interpretation is underutilized in clinical settings. The objectives of this study were to describe patterns of interpreter use in a pediatric emergency department (ED), to determine factors associated with its use, and to examine differences in outcomes between EP families and those with LEP. METHODS ED encounters for LEP and EP patients were reviewed in a retrospective cohort study design over a 15 month period. Generalized estimating equations were used to compare patient encounters and factors associated with interpreter use. RESULTS Interpreter use for families who preferred a non-English language was 45.4%. Use of interpretation was less likely during busier times of day (odds ratio [OR] 0.85, confidence interval [CI] 0.78-0.93), with a lower triage acuity (OR 0.66, CI 0.62-0.70), and with each increasing year of patient age (OR 0.97, CI 0.96-0.98). LEP patients who did not receive interpretation were less likely to be admitted than EP patients (OR 0.69, 0.62-0.78). Patients of LEP families, with or without interpretation, were more likely to be transferred to the ICU within 24 hours of admission than patients of EP families (OR 1.76, 1.07-2.90; 1.85, 1.08-3.18) suggesting that an aspect of clinical severity may have been missed in the ED. CONCLUSIONS Professional interpretation is currently underutilized in this ED for patients with LEP, and important differences in outcomes exist between LEP and EP patients. Factors associated with interpreter use will inform ongoing improvement efforts.
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Affiliation(s)
- Emily A Hartford
- Seattle Children's Hospital, University of Washington, Seattle, Wash.
| | - Andrea P Anderson
- Seattle Children's Hospital, University of Washington, Seattle, Wash
| | - Eileen J Klein
- Seattle Children's Hospital, University of Washington, Seattle, Wash
| | - Derya Caglar
- Seattle Children's Hospital, University of Washington, Seattle, Wash
| | - Kristy Carlin
- Seattle Children's Hospital, University of Washington, Seattle, Wash
| | - K Casey Lion
- Seattle Children's Hospital, University of Washington, Seattle, Wash
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Abstract
OBJECTIVE To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients. METHODS This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED. RESULTS The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40-2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22-2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46-0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08-0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22-1.01). CONCLUSIONS In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.
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Affiliation(s)
- Heather G. Zook
- Department of Research and Sponsored Programs, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
- Department of Evaluation, Professional Data Analysts, Inc., 219 Main Street SE, Suite 302, Minneapolis, MN 55414
| | - Nathaniel R. Payne
- Department of Research and Sponsored Programs, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
- Department of Quality and Safety, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
| | - Susan E. Puumala
- Center for Health Outcomes and Prevention Research, Sanford Research, 2301 E 60th Street North, Sioux Falls, SD 57104
- Department of Pediatrics, Sanford School of Medicine at the University of South Dakota, 1400 W 22nd Street, Sioux Falls, SD 57105
| | - Katherine Burgess
- Center for Health Outcomes and Prevention Research, Sanford Research, 2301 E 60th Street North, Sioux Falls, SD 57104
- Department of Epidemiology, Colorado School of Public Health at the University of Colorado at Denver, 13001 East 17 Place, Aurora, CO 80045
| | - Anupam B. Kharbanda
- Department of Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
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