Key Result

No statistical differences were reported in ESI, triage pain score, or acute ED visits but there was a longer ED LOS observed in DHH ASL patients.

• Emergency Severity Index (ESI): When compared to non-DHH English speakers, neither DHH ASL users nor DHH English speakers had higher odds of being classified into lower-acuity ESI levels.
• Triage Pain Score: On a scale of 0 to 10 the mean score was 5.8 and the median was 7. Neither of the DHH patient groups had pain scale ratings significantly different than non-DHH English speakers.
• Acute ED Revisit: This was defined as a return within nine days; 10 percent of patients had acute revisits to the ED. There was no statistical difference between the groups for this metric.
• Length of Stay (LOS): DHH ASL-using patients stayed in the ED 9 percent longer than non-DHH English-speaking patients (IRR, 1.09; 95 percent CI, 1.05 to 1.13; P=0.016). On average, this equated to approximately 30 min longer ED LOS (95 percent CI, 17 to 44 min). There were no significant differences between DHH English-speaking patients and non-DHH English speakers.

EBM Commentary

1. Cohort Selection: The authors of this study selected the cohort based upon patients who utilized any of the medical center facilities and then select those who presented to the ED, as opposed to just isolating DHH patients from all ED visits.
2. Nine Day Return Visit: It was unusual for the authors to select nine days for the return visit metric. Often in ED literature, we see 72-hour or one-week return visit reported.
3. Length of Stay: The only metric measured that was statistically different was the ED LOS. It was 30 minutes longer in DHH ASL using patients or approximately 9 percent compared to non-DHH English-speaking patients. It is unclear if this is clinically significant, and we should be cautious not to over-interpret single-center, retrospective, observational data.

Skeptic’s Guide Bottom Line

Deaf and hard-of-hearing patients should be triaged and treated with the same level of concern and care as other patients. Use of interpreter services is essential, as with any non-English speaking patient.

Case Resolution

Obtain an on-site interpreter ASL services in your ED. This is preferred to online, remote interpreter systems due to technical difficulties and lack of staff training.⁷

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.

Thank you to Dr. Corey Heitz, an emergency physician in Roanoke, Virginia, for his help with this review.