Are diagnostic testing and admission rates higher in non-English-speaking versus English-speaking patients in the emergency department?

M A Waxman, M A Levitt
Annals of Emergency Medicine 2000, 36 (5): 456-61

STUDY OBJECTIVE: To determine whether non-English-speaking patients who present to an emergency department have more diagnostic tests ordered, higher admission rate, and longer length of stay in the ED than English-speaking patients for 2 common complaints, chest pain and abdominal pain.

METHODS: This prospective, comparative, observational study was conducted at a public hospital ED. The study group was composed of 324 patients (172 non-English-speaking and 152 English-speaking) presenting with nontraumatic abdominal pain (148) or chest pain (176). The main outcome measures were admission rates, length of stay in the ED, and diagnostic test and procedure ordering.

RESULTS: The mean age for the total sample was 45.8+/-15.5 years (range 14 to 87 years); 45.4% (147/324) of the patients were male. For the non-English-speaking patients, the language distribution was Spanish (31.0%), other (9.0%), Cantonese (5.9%), Hindi (2.5%), Mien (1.5%), Arabic (1.9%), Russian (0.9%), Mandarin (0.6%), and Korean (0.3%). The admission rate was 37.8% for English-speaking patients versus 42.8% for non-English-speaking patients in the total sample (mean difference in proportions 5%, 95% confidence interval [CI] -6% to 16%; 34.2% for English-speaking versus 9.1% for non-English-speaking patients presenting with abdominal pain, mean difference in proportions 5%, 95% CI -11% to 21%) and 40.9% for English-speaking versus 45.8% for non-English-speaking patients presenting with chest pain (mean difference in proportions 5%, 95% CI -10% to 20%). Power was 80% to detect a 15% difference in admission rates at an alpha value of.05. There was no statistically significant difference in ordering of diagnostic tests between the non-English-speaking and English-speaking patients with chest pain. Non-English-speaking patients with abdominal pain had 5 tests ordered more often than English-speaking patients. The mean difference in proportions (with 95% CIs) for these tests were CBC count 18.4% (5.1% to 31.7%), serum electrolytes 17.9% (3.8% to 31. 9%), urinalysis 20.0% (4.5% to 35.6%), ECG 23.4% (8.6% to 38.2%), and abdominal computed tomographic scan 10.9% (1.0% to 20.8%). There was no statistically significant difference between English-speaking and non-English-speaking patients for ED length of stay in the total sample (mean difference 29.8, 95% CI -37.5 to 97.1 minutes; for the abdominal pain subgroup, mean difference 19.5, 95% CI -74.6 to 113.5 minutes; and for the chest pain subgroup, mean difference 37.9, 95% CI -58.0 to 133.8 minutes).

CONCLUSION: Significantly more tests are ordered for non-English-speaking patients with abdominal pain in the ED, including 3 times as many abdominal computed tomographic scans. There is no increase in test ordering with non-English-speaking patients with complaints of chest pain in the ED. When comparing English-speaking and non-English-speaking patients, there were no statistically significant differences in admission rates or length of stay in the ED.

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