ABSTRACTS
Prehospital Cerebrovascular Accident Diagnostic Inaccuracy in Patients with Limited English ProficiencyAuthor: Mario A Camacho, MD | | Associate Authors: Holden M. Wagstaff, MD, Esmeralda Melgoza, MPH, Edder J. Peralta, MA, NRP, NCEE, Richard M. Huff, NREMT, MS, Jamie W. Kennel, PhD MAS
Introduction Patients with limited English proficiency (LEP) experience reduced access, lower quality of care, and worse health outcomes in hospital-based care, all of which can be detrimental in time-sensitive conditions. Today, approximately 25 million people in the United States have LEP, an increase of 80% since 1990. It is currently unknown if patients with LEP face similar barriers to care when receiving treatment by emergency medical services (EMS). Objective To determine if LEP impacts the diagnostic accuracy of cerebrovascular accidents (CVA) by EMS clinicians in the prehospital setting. Methods Using descriptive and multivariate logistic regression models, a retrospective analysis was conducted on 20,138 cases from the 2022 national ESO dataset. Diagnostic accuracy was determined by comparing EMS clinician impressions with CVAs diagnosed in the emergency department (ED). LEP was identified when listed as a barrier to care by EMS. The analytic sample was limited to ALS/BLS 9-1-1 transports of patients 18 years and older with a recorded ED diagnosis of CVA as determined by ICD-10 codes. Results Patients with LEP who were having a CVA were 19% less likely (aOR: 0.81, 95% CI: 0.67–0.98]) to be correctly identified by EMS clinicians compared to patients without LEP when adjusting for patient age, race, and gender. Conclusion This study suggests that language barriers between EMS clinicians and patients may impact the accurate recognition of CVAs in the prehospital setting. Given the critical role that timely CVA diagnosis and treatment have on morbidity and mortality, understanding the mechanisms underpinning this barrier and testing effective interventions can have a direct and immediate impact on health disparities for patients with LEP. Future research should consider the impact of professional medical interpretation, the effect of LEP on other health conditions, as well as patient-centered outcomes.
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