title: Parental language and dosing errors after discharge from the pediatric emergency department.
abstract: OBJECTIVE
  Safe and effective care after discharge requires parental education in the pediatric emergency department (ED). Parent-provider communication may be more difficult with parents who have limited health literacy or English-language fluency. This study examined the relationship between language and discharge comprehension regarding medication dosing.
  
  
  METHODS
  We completed a prospective observational study of the ED discharge process using a convenience sample of English- and Spanish-speaking parents of children 2 to 24 months presenting to a single tertiary care pediatric ED with fever and/or respiratory illness. A bilingual research assistant interviewed parents to ascertain their primary language and health literacy and observed the discharge process. The primary outcome was parental demonstration of an incorrect dose of acetaminophen for the weight of his or her child.
  
  
  RESULTS
  A total of 259 parent-child dyads were screened. There were 210 potential discharges, and 145 (69%) of 210 completed the postdischarge interview. Forty-six parents (32%) had an acetaminophen dosing error. Spanish-speaking parents were significantly more likely to have a dosing error (odds ratio, 3.7; 95% confidence interval, 1.6-8.1), even after adjustment for language of discharge, income, and parental health literacy (adjusted odds ratio, 6.7; 95% confidence interval, 1.4-31.7).
  
  
  CONCLUSIONS
  Current ED discharge communication results in a significant disparity between English- and Spanish-speaking parents' comprehension of a crucial aspect of medication safety. These differences were not explained purely by interpretation, suggesting that interventions to improve comprehension must address factors beyond language alone.
authors: From the *Children's Hospital of Philadelphia, Philadelphia, PA; †Children's Hospital Boston, Boston, MA; ‡The Hospital for Sick Children; and §Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors: Margaret E
authors: ME
authors: Samuels-Kalow
authors: Anne M
authors: AM
authors: Stack
authors: Stephen C
authors: SC
authors: Porter
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001835:Body Weight; D001900:Boston; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D003144:Communication Barriers; D032882:Comprehension; D062787:Drug Overdose / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000188:drug therapy; D057220:Health Literacy; D006630:Hispanic or Latino / Q000523:psychology*; D006701:Home Nursing; D006801:Humans; D007182:Income; D007223:Infant; D007802:Language; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D011939:Mental Recall; D019303:Multilingualism; D010290:Parents / Q000523:psychology*; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D011368:Professional-Family Relations; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D000082:Acetaminophen