title: Presenting characteristics and processing times for culturally and linguistically diverse (CALD) patients with chest pain in an emergency department: Time, Ethnicity, and Delay (TED) Study II.
abstract: BACKGROUND
  To date there has been limited published data presenting the characteristics and timeliness of the management in an Emergency Department (ED) for culturally and linguistically diverse (CALD) patients presenting with chest pain. This study aimed to describe the presenting characteristics and processing times for CALD patients with chest pain compared to the Australian-born population, and current guidelines.
  
  
  METHODS
  This study was a cross sectional analysis of a cohort of patients who presented with chest pain to the metropolitan hospital between 1 July 2012 and 30 June 2014.
  
  
  RESULTS
  Of the total study population (n=6640), 1241 (18.7%) were CALD and 5399 (81.3%) were Australian-born. CALD patients were significantly older than Australian-born patients (mean age 62 vs 56years, p<0.001). There were no differences in the proportion of patients who had central chest pain (74.9% vs 75.7%, p=0.526); ambulance utilisation (41.7% vs 41.1%, p=0.697); and time to initial treatment in ED (21 vs 22min, p=0.375). However, CALD patients spent a significantly longer total time in ED (5.4 vs 4.3h, p<0.001). There was no difference in guideline concordance between the two groups with low rates of 12.5% vs 13%, p=0.556. Nonetheless, CALD patients were 22% (95% CI, 0.65, 0.95, p=0.015) less likely to receive the guideline management for chest pain.
  
  
  CONCLUSIONS
  The initial emergency care was equally provided to all patients in the context of a low rate of concordance with three chest pain related standards from the two guidelines. Nonetheless, CALD patients spent a longer time in ED compared to the Australian-born group.
authors.affiliation: School of Nursing and Midwifery, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia. Electronic address: kannikar.w@flinders.edu.au.
authors.forename: Kannikar
authors.initials: K
authors.lastname: Wechkunanukul
authors.affiliation: Paramedic Department, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia. Electronic address: hugh.grantham@flinders.edu.au.
authors.forename: Hugh
authors.initials: H
authors.lastname: Grantham
authors.affiliation: Paramedic Department, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia. Electronic address: david.teubner@flinders.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Teubner
authors.affiliation: The George Institute for Global Health, Cardiovascular division, Sydney Medical School, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW 2050, Australia. Electronic address: khyun@georgeinstitute.org.au.
authors.forename: Karice K
authors.initials: KK
authors.lastname: Hyun
authors.affiliation: School of Nursing and Midwifery, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia. Electronic address: robyn.clark@flinders.edu.au.
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000208:ethnology; D002637:Chest Pain / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D004636:Emergency Service, Hospital / Q000639:trends*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends*
keywords: Acute coronary syndromes; Chest pain; Culturally and linguistically diverse; Emergency department; Emergency medical service; Ethnicity