Diagnostic Yield of Computed Tomography of the Abdomen in Patients Who Prefer a Language Other Than English in the Emergency Department

Over 20% of the US population speaks a language other than English at home. Studies indicate that when patients with a preferred language other than English (PLOE) present to the Emergency Department (ED), they undergo a higher rate of testing than their English speaking counterparts. It is unclear if this represents true inefficiency in test selection, or other factors associated with language. Stowell and colleagues evaluated diagnostic yield for computed tomography (CT) for pulmonary embolism (PE), and found no significant difference in diagnostic yield for CTPE between English and Spanish speaking patients, although patients who identified as “bilingual” had a lower diagnostic yield. The goal of this study was to evaluate the diagnostic yield of CT in patients with PLOE who presented to the ED with abdominal pain.

We performed a retrospective cohort study of patients presenting to the Denver Health ED with a chief complaint of abdominal pain in 2022, analyzing the relationship between the dependent variable of diagnostic yield and the independent variable of patient’s preferred language (English, Spanish and other languages). Diagnostic yield was determined by using the results of CT imaging studies of the abdomen and pelvis performed among the eligible patient cohort, stratified by preferred language, and defined as the number of disease-positive patients divided by the total preferred language cohort size. Disease positivity was defined based on existing literature, and then determined by trained EM physician chart abstractors. Bivariate statistical tests were used to compare variables initially, and to inform the development of a binary logistic regression model.

A total of 7,595 patients were included in the cohort. Of these, 5,154 (68%) preferred English, 2,056 (27%) preferred Spanish, and 385 (5%) preferred other languages. After adjusting for race/ethnicity, sex, disposition and acuity, there was no significant difference in diagnostic yield in CT abdomen/pelvis for patients with PLOE when compared to their English speaking counter parts (aOR 1.47; 95% CI 0.85-2.55).

There was no significant difference in diagnostic yield between patients with PLOE and patients who prefer English, despite multiple studies indicating this patient population experiences a higher testing rate. Further study as to factors that contribute to this discrepancy are warranted.