Some errors were correct translations of errant English instructions, but overall, content was inaccurate owing to grammar or typographical errors ( Table 2) that would readily have been overlooked or understood by a reader of the English text. A minority of inaccurate translations had potential for clinically significant harm: in Spanish, 15 (28%) of 53 inaccuracies and 15 (2%) of 647 sentences in Chinese, 50 (40%) of 125 inaccuracies and 50 (8%) of 647 sentences. Overall, 594 (92%) and 522 (81%) sentences were accurately translated into Spanish and Chinese, respectively, by GT ( Table 1). The 100 sets of patient instructions contained 647 sentences.
Variables with significance of P < .20 in bivariate analyses were used in multivariable analyses. We used logistic regression analyses stratified by language to assess associations between sentence characteristics and accuracy and/or harm. 6 For analyses, we used a binary variable (clinically significant/life-threatening vs clinically nonsignificant/no harm). Potential for harm from inaccurate translations was assessed by 2 clinicians (with a third adjudicating) using an established rating system: clinically nonsignificant, clinically significant, and life-threatening potential harm. A second translator reviewed back-translations deemed inaccurate to ensure these were not back-translator error. Two clinicians coded accuracy independently a third adjudicated disagreements. The primary outcome was sentence translation accuracy, assessed for overall content accuracy, not word-for-word accuracy, and coded as a binary outcome. Using GT we translated instructions into Spanish and Chinese, and then bilingual translators translated the text back into English. Content categories included explanation of diagnosis and/or results, follow-up instructions, medication instructions, return precautions, and greeting. 4 We analyzed each sentence by content category Flesch-Kincaid readability score use of medical jargon, 5 such as atypical use of normal words (eg, positive test result) or medical terminology and presence of nonstandard English (spelling or grammar errors, abbreviations, colloquial English, proper nouns).
We abstracted 100 free-texted ED discharge instructions and oversampled for medication changes and common complaints.
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