Waxman M A, Levitt M A
Albany Medical College, Albany, NY.
Ann Emerg Med. 2000 Nov;36(5):456-61. doi: 10.1067/mem.2000.108315.
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.
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.
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).
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.
确定因胸痛和腹痛这两种常见病症前往急诊科就诊的非英语患者，与英语患者相比，是否接受了更多的诊断检查、具有更高的住院率以及在急诊科停留的时间更长。
这项前瞻性、对比性、观察性研究在一家公立医院急诊科进行。研究组由324例因非创伤性腹痛（148例）或胸痛（176例）就诊的患者组成（172例非英语患者和152例英语患者）。主要观察指标为住院率、在急诊科的停留时间以及诊断检查和操作的开具情况。
总样本的平均年龄为45.8±15.5岁（范围14至87岁）；45.4%（147/324）的患者为男性。对于非英语患者，语言分布为西班牙语（31.0%）、其他（9.0%）、粤语（5.9%）、印地语（2.5%）、苗语（1.5%）、阿拉伯语（1.9%）、俄语（0.9%）、普通话（0.6%）和韩语（0.3%）。总样本中，英语患者的住院率为37.8%，非英语患者为42.8%（比例平均差异为5%，95%置信区间[CI]为-6%至16%；因腹痛就诊的英语患者为34.2%，非英语患者为9.1%，比例平均差异为5%，95%CI为-11%至21%）；因胸痛就诊的英语患者为40.9%，非英语患者为45.8%（比例平均差异为5%，95%CI为-10%至20%）。在α值为0.05时，检测住院率15%差异的检验效能为80%。胸痛的非英语患者和英语患者在诊断检查开具方面无统计学显著差异。腹痛的非英语患者比英语患者多接受5项检查。这些检查的比例平均差异（及95%CI）分别为全血细胞计数18.4%（5.1%至31.7%）、血清电解质17.9%（3.8%至31.9%）、尿液分析20.0%（4.5%至35.6%）、心电图23.4%（8.6%至38.2%）以及腹部计算机断层扫描10.9%（1.0%至20.8%）。总样本中，英语患者和非英语患者在急诊科的停留时间无统计学显著差异（平均差异29.8，95%CI为-37.5至97.1分钟；腹痛亚组中，平均差异19.5，95%CI为-74.6至113.5分钟；胸痛亚组中，平均差异37.9，95%CI为-58.0至133.8分钟）。
急诊科中腹痛的非英语患者接受的检查显著更多，包括腹部计算机断层扫描的次数是英语患者的3倍。急诊科中胸痛的非英语患者在检查开具方面没有增加。比较英语患者和非英语患者时，住院率和在急诊科的停留时间无统计学显著差异。
