Association of Spoken Language With Rates of Neuroimaging and Intravenous Analgesia in Children With Headache in the...

Patients who speak languages other than English (LOE) may be at risk of adverse health outcomes.

The objective of this study was to evaluate the association of language with diagnostic testing rates and analgesia choice among children with headaches in the emergency department (ED). We hypothesized that spoken language would be associated with rates of neuroimaging and analgesia choice.

We conducted a cross-sectional study of children 5-17 years old discharged from an emergency department in Iowa, Maryland, or New Jersey in 2019-2020 with a primary diagnosis of headache. Language was defined as English, Spanish, or other. The outcomes were neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]) and intravenous analgesia administration, identified using procedure codes. We used logistic regression to evaluate the associations of language and each outcome, adjusting for age, sex, payor, neighborhood income, state, migraine versus non-migraine diagnosis, and complex chronic condition.

Neuroimaging was performed in 22.7% of English-, 17.3% of Spanish-, and 22.4% of other language-speakers. Compared with English, there was only an association between neuroimaging and Spanish (adjusted odds ratio [aOR] 0.83, 95% CI: 0.72-0.95). Intravenous medications were administered in 41.6% English-, 28.0% Spanish-, and 33.7% other language-speakers. Compared with primary English speakers, there was no association between Spanish language (aOR: 0.91, 95% CI: 0.80-1.04) or other language (aOR: 1.18, 95% CI: 0.95-1.45) and intravenous analgesia.

There was an association between LOE and neuroimaging. This evaluation should be repeated across different conditions to understand under what conditions language is associated with clinical decision-making and care.