O3238: Perception of Fever and Management Practices in Spanish-Speaking Patients in the Pediatric Emergency Department

Background: Fever, the most common pediatric chief complaint, accounts for 15% of all emergency department (ED) visits. However, fever phobia, an exaggerated fear of the consequences of fever, is particularly significant among Spanish-speaking caregivers. Studies have shown that this fear often leads to non-emergent ED visits due to a belief that fever can cause severe harm.   

Our primary aim is to determine the baseline level of knowledge of fever among Spanish-speaking caregivers in the pediatric ED. Our secondary aims are to evaluate if caregivers' understanding of fever improved during their visit and if their fever phobia decreased and to measure the efficacy of education intervention provided in Spanish by measuring 72-hour return rates.

Methods: This is a prospective study on Spanish-speaking families presenting to a community pediatric ED with a chief complaint of fever who requested an interpreter. Native Spanish-speaking pediatric emergency medicine and Infectious Disease physicians developed educational materials focused on fever. Healthcare providers administered fever education and discharge instructions utilizing the teach-back method. Subsequently, caregivers enrolled in the study completed an electronic survey to assess their comprehension of the information provided during their visit and its impact on their understanding of fever. A fever knowledge score was derived from caregivers' survey responses. We tracked the 72-hour return rate for enrolled patients and reviewed discharge instructions to assess the language and clarity.

Results: Among the 143 caregivers enrolled, 87% believed fever to be dangerous, and 94% were concerned about febrile seizures and brain damage. The mean fever knowledge score prior to fever education was 2.3/6. After ED education, 60% of families expressed a change in their perception of the causes of fever and 85% changed their perception of the harmful effects of fever. Seventy-three percent of families received language-concordant written instructions, and 88% expressed understanding of the discharge instructions given. About 15% of patients returned to the ED within 72-hours with the same chief complaint.

Conclusion: In conclusion, our study underscores the significant fever phobia among Spanish-speaking caregivers in the Hispanic community. While interpreters and standardized education in Spanish have led to positive shifts in perceptions for many families, there is a clear need for enhanced language-concordant care and culturally sensitive fever education. Twenty-seven percent of our caregivers did not receive written instructions in their preferred language, which may contribute to suboptimal knowledge scores and higher return rates to the ED. We should collaborate to develop consistent tools that facilitate effective communication and fever disease management and potentially reduce healthcare utilization for caregivers with limited English proficiency.