Language and Trauma: Is Care Equivalent for Those Who do not Speak English?

Abstract

Aim: Few studies examine the relationship of language and surgical outcomes. Language is not included as a variable in many databases. The aim of this study was to examine the association of language and outcomes in trauma. Materials and methods: A 5-year retrospective review was performed at a level I trauma center. All adult trauma patients with a non-English primary language were matched to an English-speaking cohort by age, gender, injury mechanism, initial Glasgow coma scale (GCS), and injury severity score (ISS). Analysis included an unpaired two-tailed Student’s t test for continuous variables and a Fisher’s exact test for categorical variables. Results: Three hundred ninety-five non-English-speaking patients were identified. There was no difference in mortality, intubation rate, number of ventilator days, average hospital length of stay, readmission rates, or rates of nine complications, even when stratified for high ( ≥ 15) vs low ( ≤ 14) ISS. Non-English-speaking patients had a shorter average length of intensive care unit (ICU) stay (5.4 vs 6.9 days, p = 0.03), were mostly self-pay (236, 59.7% vs 127, 32.2%, p < 0.01), and were more likely to be discharged home (340, 86.1% vs 309, 78.2%, p = 0.01). Conclusion: Despite similar outcomes, non-English-speaking trauma patients left the ICU more quickly, were more likely self-pay, and more likely to be discharged home. Clinical significance: These findings raise concerns about possible disparities in trauma care for non-English speaking patients and highlight the importance of inclusion of language as a variable in patient registries and national databases. Future studies should investigate additional potentially significant socioeconomic factors.