Medical College of Wisconsin
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Caregiver low health literacy and nonurgent use of the pediatric emergency department for febrile illness. Acad Pediatr 2014 Sep-Oct;14(5):505-9



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85027929907   34 Citations


OBJECTIVE: To examine the association between caregiver health literacy and the likelihood of a nonurgent emergency department (ED) visit in children presenting for fever.

METHODS: This cross-sectional study used the Newest Vital Sign to assess the health literacy of caregivers accompanying children with fever to the ED. Visit urgency was determined by resources utilized during the ED visit. Findings were stratified by race and child age. Chi-square and logistic regression analysis controlling for race were conducted to determine the association between low health literacy and ED visit urgency.

RESULTS: A total of 299 caregivers completed study materials. Thirty-nine percent of ED visits for fever were nonurgent, and 63% of caregivers had low health literacy. Low health literacy was associated with a higher proportion of nonurgent ED visits for fever (44% vs 31%, odds ratio 1.8, 95% confidence interval [CI] 1.1, 2.9). Low health literacy was associated with higher odds of a nonurgent visit in white and Hispanic caregivers but not in black caregivers. In regression analysis, children ≥ 2 years old had higher odds of a nonurgent visit if caregivers had low health literacy (adjusted odds ratio 2.0; 95% CI 1.1, 4.1); this relationship did not hold for children <2 years old (adjusted odds ratio 0.8; 95% CI 0.4, 1.8).

CONCLUSIONS: Nearly two-thirds of caregivers with their child in the ED for fever have low health literacy. Caregiver low health literacy is associated with nonurgent ED utilization for fever in children over 2 years of age. Future interventions could target health literacy skills regarding fever in caregivers of children ≥ 2 years.

Author List

Morrison AK, Chanmugathas R, Schapira MM, Gorelick MH, Hoffmann RG, Brousseau DC


David Brousseau MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Andrea Morrison MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

African Americans
Age Factors
Child, Preschool
Cross-Sectional Studies
Educational Status
Emergency Service, Hospital
Health Literacy
Health Services Misuse
Middle Aged
Odds Ratio
Young Adult