(P48) Language Spoken and CT Utilization in the Emergency Department

Objectives: This study aims to analyze the potential relationship between the utilization rates of CT scans in four common ED complaints (dizziness, headache, chest pain, abdominal pain) and the patient’s primary language.

Background: Initial workup in the Emergency Department (ED) often includes computerized tomography (CT) as an imaging modality. However, rates of CT utilization may differ depending on the patient’s primary language. In 2002, a literature review on overall quality of care in Latino patients, found language as a barrier to care in 86% of studies. Prior studies show that non English speaking patients were less satisfied with their ED care and were less likely to obtain follow up appointments after their visit. A study of pediatric patients with fractures revealed that non English speaking patients experienced delays in receiving pain medications.

Methods: The HCA Healthcare database contains visit specific information from all HCA Healthcare affiliated hospitals in South Florida. Information for visits in which the chief complaint was dizziness, chest pain, abdominal pain or headache, as well as primary language spoken by the patient. Included in the study are patients between 18 and 95 years of age who presented to HCA Healthcare EDs in South Florida. Patients under 18 and over 95 years of age were excluded. Charts where language spoken was not specified were also excluded. CT scan utilization rates for 4 non-specific generalized common ED chief complaints (dizziness, headache, chest pain, abdominal pain) were obtained. 46,636 patient visits were included in the study. All data was de-identified. Chi-square testing was used to determine the statistical significance in CT utilization rates among primarily English speaking and non-English speaking patients.The Chi-Square Test of Independence was used to determine whether the frequency of CT scans significantly differed in English and non-English patients.

Results: 57.5% of English speaking patients vs 60.5% of non English speaking patients had a CT ordered during their ED visit (p < 0.001). Analyzing language specific data, those who spoke Creole (69.4%) were most likely to have a CT as part of their workup, followed by Russian (65.2%), then Spanish (60.4%), and lastly English (57.0%) (p < 0.001). In this study, we found a significant difference in CT utilization for specific chief complaints in the ED between patients speaking Creole and English, Creole and Spanish, and English and Spanish. Russian speaking patients did not differ significantly in CT utilization rates. Creole and Spanish speaking patients who presented to the ED were 20% and 6%, respectively, more likely to receive advanced imaging than English speaking patients for the frequent ED chief complaints of dizziness, abdominal pain, chest pain and headache (p < 0.001). These findings suggest that there is a significant difference in CT scan utilization in the ED between patients based on language spoken.

Conclusions: This study demonstrates a relationship between CT utilization and preferred language in the ED. More specifically, language barriers resulted in increased frequency of CT imaging, with Creole speaking patients most likely to receive advanced imaging. Although a specific causation for this finding cannot be determined from this preliminary study, it indicates that difficulty in history taking and miscommunication may lead to more resource utilization. Further studies will need to determine whether socio-economic factors, insurance status and patient follow up are confounding factors. Future studies should also be undertaken to determine if language spoken affects other aspects of emergency department care.

References (Optional): 1.. Bureau, U. S. C. (2021, December 16). Detailed languages spoken at home and ability to speak English for the population 5 years and over: 2009-2013. Census.gov. Retrieved October 2022, from https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html
2. Tang S., Carrasquillo O, Stuart GW. et al. (2002, April 8). The impact of language barriers on the health care of Latinos in the United States: A review of the literature and Guidelines for Practice. Journal of Midwifery & Women's Health. 2002; 47(2): 80-96. 3. Sarver J, Baker D. Effect of language barriers on follow-up appointments after an emergency department visit. J Gen Intern Med. 2000;15:256-264.
4. Carrasquillo O., Orav, E. J., Brennan, T. A., & Burstin, H. R. (1999). Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine. 1999;14(2), 82–87.
5. Gaba M, Vazquez H, Homel P etal. Language barriers and timely analgesia for long bone fractures in a pediatric emergency department. Western Journal of Emergency Medicine. 2021; 22(2): 225- 231.
6. Hampers LC, Cha S, Gutglass D et al. Language barriers and resource utilization in a pediatric ED. Pediatrics. 1999:103(6):1253-1256.

Funding (Optional): HCA Database was used to gather data and an HCA hired statistician analyzed the data..