Michael N Levas1, Peter S Dayan2, Manoj K Mittal3, Michelle D Stevenson4, Richard G Bachur5, Nanette C Dudley6, Lalit Bajaj7, Charles G Macias8, Jonathan Bennett9, M Denise Dowd10, Avis J Thomas11, Anupam B Kharbanda12. 1. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. Electronic address: mnlevas@mcw.edu. 2. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY. 3. Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 4. Department of Pediatrics, University of Louisville, Louisville, KY. 5. Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA. 6. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 7. Department of Pediatrics, University of Colorado School of Medicine, Denver, CO. 8. Department of Pediatrics, Baylor College of Medicine, Houston, TX. 9. Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, DE. 10. Division of Pediatrics, University of Missouri, Kansas City Children's Mercy Hospital, Kansas City, MO. 11. Division of Biostatistics, University of Minnesota, Minneapolis, MN. 12. Department of Pediatric Emergency Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, MN.
Abstract
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.
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.
Authors: Heather G Zook; Nathaniel R Payne; Susan E Puumala; Katherine M Ziegler; Anupam B Kharbanda Journal: Pediatr Emerg Care Date: 2019-03 Impact factor: 1.454
Authors: Monika K Goyal; Nathan Kuppermann; Sean D Cleary; Stephen J Teach; James M Chamberlain Journal: JAMA Pediatr Date: 2015-11 Impact factor: 16.193