Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Surg Res. 2024 Oct;302:540-554. doi: 10.1016/j.jss.2024.07.097. Epub 2024 Aug 22.
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.
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.
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.
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.
随着全球化和多样性的不断增加，移民和语言障碍的交集可能会影响患者的结局。本范围综述旨在总结目前关于移民和语言障碍对儿科手术结局影响的证据。
根据系统评价和荟萃分析的首选报告项目指南进行了系统综述。使用描述儿科手术、移民、英语水平有限 (LEP) 和难民的医学主题词，在 2000 年至 2023 年间在四个数据库中进行了搜索。四名独立审查员筛选和分析文本以最终纳入。
共纳入 33 项研究。有 10 项研究描述了疾病的发生率和严重程度，发现 LEP、移民和难民患者在阑尾炎和创伤性损伤中更有可能出现严重疾病。五项研究描述了疼痛管理，发现 LEP 患者接受的疼痛评估较少，等待镇痛的时间更长，疼痛评分的差异更大。有 17 项研究调查了治疗的接受和延迟，发现移民和 LEP 患者的治疗时间更长，治疗率降低。有 17 项研究描述了手术结果，发现 LEP 患者的住院时间更长，术后急诊就诊次数更多，但随访预约次数更少。在肾移植中，LEP 患者和移民患者的结局较差，但欧洲移民中没有这种趋势。总体而言，移民和难民的并发症和死亡率更高。
LEP 患者和移民更有可能出现晚期疾病和严重损伤，接受的疼痛管理不足，手术延迟，并发症更多。需要继续评估 LEP 和移民对儿科手术结局的影响。
