Weiss N R, Weiss S J, Tate R, Oglesbee S, Ernst A A
Department of Emergency Medicine, University of New Mexico, Albuquerque, NM.
Department of Emergency Medicine, University of New Mexico, Albuquerque, NM.
Am J Emerg Med. 2015 Dec;33(12):1737-41. doi: 10.1016/j.ajem.2015.08.007. Epub 2015 Aug 7.
The population of the United States continues to diversify with an increasing percentage of residents with limited English proficiency (LEP). A major concern facing emergency medical services (EMS) providers is increasing scene and transport times. We hypothesized that there would be a significant difference in EMS scene and transport times when comparing LEP and English-speaking (ES) patients and there would be a difference in care, both in and out of hospital.
This is a retrospective case-control study with patient data extracted from hospital records and EMS run reports from a 911 emergency ambulance service. Patients were only included if they were transported to our level I trauma center. Inclusion in the LEP group was based on a field in EMS run reports that claimed language barrier as the sole reason for no patient signature. All LEP patients from July 1, 2012, to November 1, 2012, were reviewed. A random comparison sampling of ES patients from the same period was evaluated. The patients' demographic data, pain scores, interventions, medications, transport times, and scene times were analyzed. Patients were followed up from emergency department (ED) management through to disposition. Percentages were compared using 95% confidence intervals (CIs). Bivariate analysis used the Student t test and χ(2) test. A multivariable logistic regression model was created to determine predictive variables. A 5% random sampling was compared by 2 investigators for interrater agreement.
Data were collected from a total of 101 ES and 100 LEP patients. Interrater agreement was 94% between extractors. Limited English proficiency patients were significantly older (56 ± 20 years old) than ES patients (41 ± 21 years old) and more likely to be female (odds ratio [OR], 2; 95% CI, 1.1-3.3). Limited English proficiency patients had a greater mean EMS transport time of 2.2 minutes (95% CI, 0.04-4.0). The odds of LEP patients receiving electrocardiograms were greater both in the ambulance (OR, 3.7; 95% CI, 1.7-8.1) and in the ED (OR, 2.0; 95% CI, 1.1-3.3) compared to ES patients. There were no differences in additional interventions, medications administered, or pain scores obtained between the 2 groups. In a multivariable logistic regression model corrected for age, type of call, smoking history, and sex, there was no difference in transport times in LEP patients.
Compared to ES patients, LEP patients are older and more likely to be female. When corrected for differences in age, type of call, smoking history, and sex, we found no difference in scene or transport time for LEP patients. Results of this study indicate that EMS providers should be prepared for a different patient encounter when responding to 911 calls involving LEP patients rather than language variations alone.
美国人口持续呈现多样化，英语水平有限（LEP）的居民比例不断增加。紧急医疗服务（EMS）提供者面临的一个主要问题是现场和转运时间的增加。我们假设，在比较LEP患者和英语流利（ES）患者时，EMS现场和转运时间会存在显著差异，并且在院内和院外护理方面也会存在差异。
这是一项回顾性病例对照研究，患者数据从医院记录以及一家911紧急救护服务的EMS运行报告中提取。仅当患者被转运至我们的一级创伤中心时才纳入研究。纳入LEP组的依据是EMS运行报告中的一个字段，该字段将语言障碍列为无患者签名的唯一原因。对2012年7月1日至2012年11月1日期间的所有LEP患者进行了审查。对同期ES患者进行随机对比抽样评估。分析了患者的人口统计学数据、疼痛评分、干预措施、用药情况、转运时间和现场时间。对患者从急诊科管理直至出院进行随访。使用95%置信区间（CI）比较百分比。双变量分析采用Student t检验和χ²检验。创建多变量逻辑回归模型以确定预测变量。由两名研究人员对5%的随机抽样进行比较，以评估评分者间的一致性。
共收集了101例ES患者和100例LEP患者的数据。提取者之间的评分者间一致性为94%。LEP患者的年龄显著大于ES患者（56±20岁比41±21岁），且更可能为女性（优势比[OR]，2；95%CI，1.1 - 3.3）。LEP患者的平均EMS转运时间更长，为2.2分钟（95%CI，0.04 - 4.0）。与ES患者相比，LEP患者在救护车上（OR，3.7；95%CI，1.7 - 8.1）和急诊科（OR，2.0；95%CI，1.1 - 3.3）接受心电图检查的几率更高。两组在其他干预措施、用药情况或获得的疼痛评分方面没有差异。在针对年龄、呼叫类型、吸烟史和性别进行校正的多变量逻辑回归模型中，LEP患者的转运时间没有差异。
与ES患者相比，LEP患者年龄更大且更可能为女性。在对年龄、呼叫类型、吸烟史和性别差异进行校正后，我们发现LEP患者的现场或转运时间没有差异。本研究结果表明，EMS提供者在应对涉及LEP患者的911呼叫时，应做好准备迎接不同的患者情况，而不仅仅是语言差异。
