title: Effect of Hispanic ethnicity and language barriers on appendiceal perforation rates and imaging in children.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. Electronic address: mnlevas@mcw.edu.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Levas
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, KY.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Stevenson
authors.affiliation: Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Nanette C
authors.initials: NC
authors.lastname: Dudley
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Denver, CO.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.affiliation: Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, DE.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bennett
authors.affiliation: Division of Pediatrics, University of Missouri, Kansas City Children's Mercy Hospital, Kansas City, MO.
authors.forename: M Denise
authors.initials: MD
authors.lastname: Dowd
authors.affiliation: Division of Biostatistics, University of Minnesota, Minneapolis, MN.
authors.forename: Avis J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: Department of Pediatric Emergency Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, MN.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000208:ethnology; D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis* / Q000208:ethnology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler