Emergency Department Care Differences for Abdominal Pain: A Multicenter Analysis of Language‑Based Disparities

Prior studies suggest that patients with a primary language other than English (PLOE) are less likely to receive the standard of care in the Emergency Department (ED) when presenting with abdominal pain. Existing studies have largely focused on single ED settings and opioid administration, prompting the need to examine additional care processes, including pain screening, imaging modality, length of stay, and analgesic administration.

We conducted a retrospective cohort study of ED patients presenting with a chief complaint of abdominal pain from 2018 to 2024. We excluded interfacility transfers, patients who died in the ED, individuals with missing sex data, and those with documented analgesic allergies. Among 54,814 abdominal pain presentations, 42,038 met inclusion criteria across one urban and two suburban EDs. Outcomes included pain screening, diagnostic imaging, analgesics, opioid administration, and ED length of stay. Covariates included PLOE status, race, ethnicity, sex, and initial pain score. Descriptive analysis, logistic, and linear regression models were used to characterize the sample and assess associations while adjusting for clinical and demographic covariates.

Descriptive analyses indicated that PLOE patients comprised 6,994 (17%) of the sample. Compared with non-PLOE patients, a greater proportion of PLOE patients were female (61% vs. 57%) and had documented severe pain (50% vs 46%), while a smaller proportion received pain screening (80% vs 86%). Regression analyses indicated several significant associations, including lower odds of pain screening (aOR 0.67; CI 0.62, 0.73; p < .001), opioid administration (aOR 0.83; CI 0.77, 0.89; p < .001), diagnostic imaging (aOR 0.88; CI 0.83, 0.94; p < .001), and a slightly longer average ED LOS (B -12.2; CI -18.55, -5.84; p<.001) among PLOE patients when compared with non-PLOE patients.

The findings both reinforce previous evidence surrounding opioid administration in PLOE patients and signal a possible deficit in care in the management of ED abdominal pain, as evidenced by language-based differences in diagnostic and treatment approaches, particularly in pain screening. However, this potential deficit cannot be conclusively determined without comprehensive illness severity and outcomes data. Further research should be done to elicit those findings.