Who is informed of trauma informed care? Patients' primary language and comprehensiveness of initial trauma assessment

BACKGROUND: For patients with limited English proficiency, language poses a unique challenge in patient-provider communication. Using certified medical interpretation (CMI) can be difficult in time- and resource-limited settings including trauma. We hypothesized that there would be limited use of CMI during major trauma resuscitations, less comprehensive assessments, and less empathetic communication for Spanish-speaking patients (SSPs) with limited English proficiency compared with English-speaking patients (ESPs). METHODS: We analyzed video-recorded encounters of trauma initial assessments at a Level 1 trauma center. Each encounter was evaluated from patient arrival until completion of the secondary survey per Advanced Trauma Life Support protocol. A standard checklist of provider actions was used to assess comprehensiveness of the primary and secondary surveys and communication events such as provider introduction, reassurances, and communicating next steps to patients. We compared the SSP and ESP cohorts for significant differences in completion of checklist items. RESULTS: Fifty patients with Glasgow Coma Scale scores of 14 and 15 were included (25 SSPs, 25 ESPs). The median age was 34 years (interquartile range, 25–65 years) for SSPs and 40 years (interquartile range, 29–54 years) for ESPs. In SSPs, 72% were male; in ESPs, 60% were male. Spanish-speaking patients received less comprehensive motor (48% complete SSPs vs. 96% ESPs, p < 0.001) and sensory (4% complete SSPs vs. 68% ESPs, p < 0.001) examinations, and less often had providers explain next steps (32% SSPs vs. 96% ESPs, p < 0.001) or reassure them (44% SSPs vs. 88% ESPs, p = 0.001). No patients were asked their primary language. Two SSP encounters (8%) used CMI; most (80%) used ad hoc interpretation, and 12% used English. CONCLUSION: We found significant differences in the initial care provided to trauma patients based on primary language. Inclusion of an interpreter as part of the trauma team may improve the quality of care provided to trauma patients with limited English proficiency.