Effect of Hispanic Ethnicity and Language Barriers on Appendiceal Perforation Rates and Imaging in Children

Objective To determine the association between Hispanic ethnicity and limited English proficiency (LEP) and the rates of appendiceal perforation and advanced radiologic imaging (computed tomography and ultrasound) in children with abdominal pain. Study design We performed a secondary analysis of a p...

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Bibliographic Details
Published in:The Journal of pediatrics 2014-06, Vol.164 (6), p.1286-1291.e2
Main Authors: Levas, Michael N., MD, Dayan, Peter S., MD, MSc, Mittal, Manoj K., MD, Stevenson, Michelle D., MD, Bachur, Richard G., MD, Dudley, Nanette C., MD, Bajaj, Lalit, MD, MPH, Macias, Charles G., MD, MPH, Bennett, Jonathan, MD, Dowd, M. Denise, MD, MPH, Thomas, Avis J., MS, Kharbanda, Anupam B., MD, MSc
Format: Article
Language:English
Subjects:
Abdominal Pain - diagnosis
Abdominal Pain - ethnology
Adolescent
Appendectomy - adverse effects
Appendectomy - methods
Appendicitis - diagnosis
Appendicitis - ethnology
Appendicitis - surgery
Child
Child, Preschool
Communication Barriers
Cross-Sectional Studies
Diagnostic Imaging - methods
Emergency Service, Hospital
Female
Follow-Up Studies
Hispanic Americans - statistics & numerical data
Humans
Male
Pediatrics
Prospective Studies
Reference Values
Risk Assessment
Tomography, X-Ray Computed - methods
Treatment Outcome
Ultrasonography, Doppler
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Summary:Objective To determine the association between Hispanic ethnicity and limited English proficiency (LEP) and the rates of appendiceal perforation and advanced radiologic imaging (computed tomography and ultrasound) in children with abdominal pain. Study design We performed a secondary analysis of a prospective, cross-sectional, multicenter study of children aged 3-18 years presenting with abdominal pain concerning for appendicitis between March 2009 and April 2010 at 10 tertiary care pediatric emergency departments in the US. Appendiceal perforation and advanced imaging rates were compared between ethnic and language proficiency groups using simple and multivariate regression models. Results Of 2590 patients enrolled, 1001 (38%) had appendicitis, including 36% of non-Hispanics and 44% of Hispanics. In multivariate modeling, Hispanics with LEP had a significantly greater odds of appendiceal perforation (OR, 1.44; 95% CI, 1.20-1.74). Hispanics with LEP with appendiceal perforation of moderate clinical severity were less likely to undergo advanced imaging compared with English-speaking non-Hispanics (OR, 0.64; 95% CI, 0.43-0.95). Conclusion Hispanic ethnicity with LEP is an important risk factor for appendiceal perforation in pediatric patients brought to the emergency department with possible appendicitis. Among patients with moderate clinical severity, Hispanic ethnicity with LEP appears to be associated with lower imaging rates. This effect of English proficiency and Hispanic ethnicity warrants further investigation to understand and overcome barriers, which may lead to increased appendiceal perforation rates and differential diagnostic evaluation.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2014.01.006