2851. Patient Language Preference and Interpreter Service Utilization Impacting Diagnostic Yield of Urinary Tract Stones Using CT
Authors * Denotes Presenting Author
  1. Sherif Zineldine *; Creighton University School of Medicine
  2. Joshua Rabang; AZ Medical Group and Family Practices
  3. Daniel Gridley; AZ Medical Group and Family Practices
  4. Albert Roh; AZ Medical Group and Family Practices
There is need for further research to outline factors affecting CT ordering preferences by emergency department (ED) providers. A recent national study demonstrated that socioeconomic factors such as race and insurance status affected the likelihood of performing CT on patients with renal colic. Patients with renal colic who were male, Hispanic, uninsured, or privately insured were more likely to receive a CT in the ED, warranting further research to understand differences in practice. The aim of this retrospective study is to assess whether patient language preference and utilization of interpreter services impact the ordering preferences and diagnostic yield of positive findings of urinary tract stones (UTS) on abdominal and pelvic noncontrast CT scans in the ED.

Materials and Methods:
Data were collected from January 1, 2019 through December 31, 2019. Data regarding age, radiological diagnosis (no stone, obstructing stone, nonobstructing stone), alternative diagnosis other than UTS, urinalysis (UA) results for blood, language demographics, and interpretive services utilization were collected. A post-collection analysis was performed to determine what yields were present based on the language spoken by the patient and when interpreter services were utilized.

A total of 683 patients were sampled, of which 438 (64%) spoke English, 189 (28%) spoke Spanish, and 45 (7%) spoke both Spanish and English. The average ages (in years) and sex distribution (% male) of the English, Spanish and bilingual patients were 44, 51, 40 years and 49%, 42%, 62%, respectively. Positive diagnostic yield for UTS was 30% (132/438) in English, 35% (66/189) in Spanish, and 51% (23/45) in bilingual patients. English speaking patients had a rate of 12% obstructive UTS followed by Spanish, then bilingual, 21% and 36%, respectively (p < .001). Spanish speakers utilized interpreters at a rate of 99% (187/189) whereas bilingual patients utilized interpreters at a rate of 51%. Bilingual patients for whom interpreters were utilized had a diagnostic yield of 50% (11/22) and 44% (10/22) for those who did not utilize interpreters, and both groups had 32% (7/22) rates of obstructive stones. There were 110 patients (16%) with alternative diagnoses other than UTS. The yields for alternative diagnosis for the English, Spanish and bilingual groups were 17%, 14%, and 15%, respectively. UA was negative for blood in 11% (24/221) of all patients with UTS. UA was also negative for blood in 8% (8/106) in obstructive UTS.

The highest yield for obstructive UTS on abdominopelvic CT was found in Spanish-speaking and bilingual patients, whereas alternative diagnoses had no significant difference between the different language preference groups. In contrast to national data suggesting overutilization of CT in certain socioeconomic groups, our data demonstrated that effective usage of interpreter services may improve communication and increase diagnostic accuracy through appropriate utilization based on our diagnostic yield.