Department of Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California.
J Emerg Med. 2024 Mar;66(3):e323-e330. doi: 10.1016/j.jemermed.2023.10.001. Epub 2023 Oct 12.
Patients with limited English proficiency seen in the emergency department (ED) experience lower quality of care and higher diagnostic resource utilization unless they are evaluated in their own language. Despite a low rate of serious pathology identified and the availability of guidelines to direct its use, computed tomography (CT) is commonly used to evaluate atraumatic headache in the ED.
Our aim was to determine whether Spanish-speaking patients with atraumatic headache were more likely than their English-speaking counterparts to undergo head CT, and whether evaluation by a clinician who passed a Spanish proficiency test mitigated this difference.
This retrospective observational study used electronic health record data of adult patients presenting with atraumatic headache to a level I trauma center during a 2-year period. Spanish-language testing of clinicians consisted of a brief, unvalidated, in-person, nonmedical verbal test administered by human resources staff.
A total of 3030 patients with atraumatic headache were identified; 1437 were English speaking and 1593 were Spanish speaking. Spanish-speaking patients were older (48.3 vs. 41.9 years), more likely to be women (68.8% vs. 60.5%), and more likely to undergo head CT (31.8% vs. 26.4%). Evaluation by a clinician who passed the Spanish proficiency test had no significant influence on the likelihood of head CT for Spanish-speaking patients after controlling for confounding variables (adjusted odds ratio 0.95; 95% CI 0.75-1.20).
Spanish-speaking patients are more likely to undergo head CT when evaluated for atraumatic headache than English-speaking patients. Evaluation by a clinician who passed a brief Spanish proficiency test did not mitigate this disparity.
在急诊科（ED）就诊的英语能力有限的患者的护理质量较低，诊断资源利用率较高，除非他们接受自己语言的评估。尽管确定的严重病理学发生率较低，并且有指导其使用的指南，但计算机断层扫描（CT）常用于评估 ED 中的无创伤性头痛。
我们的目的是确定西班牙语患者与英语患者相比，是否更有可能接受头部 CT 检查，以及通过通过西班牙语熟练程度测试的医生进行评估是否减轻了这种差异。
本回顾性观察性研究使用了 2 年内到一级创伤中心就诊的有创伤性头痛的成年患者的电子健康记录数据。对医生的西班牙语测试包括人力资源人员进行的简短、未经证实的、非医疗的现场口头测试。
共确定了 3030 例有创伤性头痛的患者；1437 例为英语患者，1593 例为西班牙语患者。西班牙语患者年龄较大（48.3 岁比 41.9 岁），更可能是女性（68.8%比 60.5%），更可能接受头部 CT（31.8%比 26.4%）。在控制混杂变量后，通过通过西班牙语熟练程度测试的医生进行评估对西班牙语患者进行头部 CT 检查的可能性没有显著影响（调整后的优势比 0.95；95%CI 0.75-1.20）。
在评估无创伤性头痛时，西班牙语患者比英语患者更有可能接受头部 CT 检查。通过通过简短的西班牙语熟练程度测试的医生进行评估并不能减轻这种差异。
