School of Medicine, University of California San Francisco, San Francisco, California.
School of Medicine, University of California San Francisco, San Francisco, California.
J Surg Res. 2022 Dec;280:326-332. doi: 10.1016/j.jss.2022.07.044. Epub 2022 Aug 26.
Disparities following traumatic injury by race/ethnicity and insurance status are well-documented. However, the relationship between limited English proficiency (LEP) and outcomes after trauma is poorly understood. This study describes the association between LEP and morbidity and mortality after traumatic injury.
A retrospective cohort study was conducted of adult trauma patients admitted to a level 1 trauma center from 2012 to 2018. Morbidity (length of stay [LOS], intensive care unit admission, intensive care unit LOS, discharge destination) and in-hospital mortality for LEP and English proficient (EP) patients were compared using univariate and multivariable logistic and generalized linear models controlling for patient demographics (age, sex, race/ethnicity, insurance) and clinical characteristics (mechanism, activation level, Glasgow Coma Scale, Injury Severity Score, traumatic brain injury).
Of the 13,104 patients, 16% were LEP patients. LEP languages included Chinese (44%) and Spanish (38%), and 18% categorized as "Other," including 33 languages. In multivariable models, LEP was statistically significantly associated with increased hospital LOS (P = 0.003) and increased discharge to home with home health services (P = 0.042) or to skilled nursing facility/rehabilitation (P = 0.006). Mortality rate was 7% for LEP versus 4% for EP patients (P < 0.0001). In multivariable analysis, speaking an LEP language other than Chinese or Spanish was statistically significantly associated with increased mortality compared to EP (P = 0.006).
Following traumatic injury, LEP patients experience increased hospital LOS and are more frequently discharged to home with home health services or to skilled nursing facilities/rehabilitation. LEP patients speaking languages other than Chinese or Spanish experience increased mortality compared to EP patients.
种族/族裔和保险状况导致的创伤后差异是有据可查的。然而，对于英语水平有限（LEP）与创伤后结果之间的关系，人们知之甚少。本研究描述了 LEP 与创伤后发病率和死亡率之间的关系。
对 2012 年至 2018 年期间入住一级创伤中心的成年创伤患者进行回顾性队列研究。使用单变量和多变量逻辑和广义线性模型比较 LEP 和英语熟练（EP）患者的发病率（住院时间[LOS]、入住重症监护病房、重症监护病房 LOS、出院目的地）和院内死亡率，同时控制患者人口统计学特征（年龄、性别、种族/族裔、保险）和临床特征（机制、激活水平、格拉斯哥昏迷量表、损伤严重程度评分、创伤性脑损伤）。
在 13104 名患者中，有 16%是 LEP 患者。LEP 语言包括中文（44%）和西班牙语（38%），18%被归类为“其他”，包括 33 种语言。在多变量模型中，LEP 与住院 LOS 增加（P=0.003）和增加到家庭健康服务（P=0.042）或熟练护理设施/康复（P=0.006）的出院率增加显著相关。LEP 患者的死亡率为 7%，而 EP 患者的死亡率为 4%（P<0.0001）。在多变量分析中，与 EP 相比，除中文或西班牙语以外的 LEP 语言与死亡率增加显著相关（P=0.006）。
创伤后，LEP 患者的住院时间延长，更常被送回家接受家庭健康服务或入住熟练护理设施/康复。与 EP 患者相比，讲中文或西班牙语以外语言的 LEP 患者死亡率增加。
