Bruce E. Lehnert MD, Presenter: Nothing to Disclose

Daniel S. Hippe MS, Abstract Co-Author: Research Grant, Koninklijke Philips NV Research Grant, General Electric Company

E. Sally Lee PhD, Abstract Co-Author: Nothing to Disclose

Lauren K. Whiteside MD, Abstract Co-Author: Nothing to Disclose

Ken Floris Linnau MD, MS, Abstract Co-Author: Speaker, Siemens AG Royalties, Cambridge University Press

To determine if patient spoken language is associated with utilization of CT and time to CT imaging in the ED for patients who present without a trauma-related complaint.

In this IRB approved, HIPAA compliant study, we retrospectively reviewed all adult ED visits from 10/1/2012 to 5/30/2013. Patient demographics, reported primary spoken language (PSL), Emergency Severity Index (ESI) score, time of ED admission and discharge, and CT (if performed) order time were recorded. Trauma and psychiatric patients, those with ESI scores 1 and 2, those with missing demographics, PSL or discharge time were excluded. The remaining patients were classified as moderate acuity (ESI=3) and low acuity (ESI=4, 5). Cox regression was used to evaluate the relationship between PSL and rate of CT while adjusting for other confounders. The association between PSL and time to CT order was assessed using generalized estimating equations (GEEs) while adjusting for other factors.

There were 17,651 ED visits by 12,124 patients which met the inclusion/exclusion criteria. 1,907 (16%) reported a non-English as their PSL. Before adjustments, a CT was ordered for 10.2% of patients with English PSL and 15.2% of patients with non-English PSL. In those for whom a CT was ordered, the average time to order was 124 +/- 93 min (English PSL) and 141 +/- 88 min (non-English PSL). After adjusting for sex, age, number of visits and time of admission, moderately acute patients with a non- English PSL had a 44% (CI: 23-68%; p<0.001) higher chance of getting a CT ordered when in the ED >1.5 hrs and had a 13.6 min longer mean time to CT order (CI: 3.0-24.3; p=0.01). Non acute patients with non-English PSL had an 88% (CI: 26-181%; p=0.002) higher chance of getting a CT ordered when in the ED >1.5 hrs and had a 41.6min longer mean time to CT order (CI: 11.2-72.0; p=0.007). CT ordering rates were comparable when done < 1.5 hrs after admission.  

Patients who report a non-English PSL have a significantly increased likelihood of undergoing CT in the ED and there is a significantly longer time to CT order placement.

Patient primary spoken language association with CT use in the Emergency Departments represents a potential source for disparity in health care between English and non-English speaking patients.

Lehnert, B, Hippe, D, Lee, E, Whiteside, L, Linnau, K, Effect of Patient Primary Spoken Language on CT Utilization in the Emergency Department.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008732.html