• Michael N Levas, Peter S Dayan, Manoj K Mittal, Michelle D Stevenson, Richard G Bachur, Nanette C Dudley, Lalit Bajaj, Charles G Macias, Jonathan Bennett, M Denise Dowd, Avis J Thomas, Anupam B Kharbanda, and Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.
• Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. Electronic address: mnlevas@mcw.edu.
• J. Pediatr. 2014 Jun 1;164(6):1286-91.e2.

ObjectiveTo determine the association between Hispanic ethnicity and limited English proficiency (LEP) and the rates of appendiceal perforation and advanced radiologic imaging (computed tomography and ultrasound) in children with abdominal pain.Study DesignWe performed a secondary analysis of a prospective, cross-sectional, multicenter study of children aged 3-18 years presenting with abdominal pain concerning for appendicitis between March 2009 and April 2010 at 10 tertiary care pediatric emergency departments in the US. Appendiceal perforation and advanced imaging rates were compared between ethnic and language proficiency groups using simple and multivariate regression models.ResultsOf 2590 patients enrolled, 1001 (38%) had appendicitis, including 36% of non-Hispanics and 44% of Hispanics. In multivariate modeling, Hispanics with LEP had a significantly greater odds of appendiceal perforation (OR, 1.44; 95% CI, 1.20-1.74). Hispanics with LEP with appendiceal perforation of moderate clinical severity were less likely to undergo advanced imaging compared with English-speaking non-Hispanics (OR, 0.64; 95% CI, 0.43-0.95).ConclusionHispanic ethnicity with LEP is an important risk factor for appendiceal perforation in pediatric patients brought to the emergency department with possible appendicitis. Among patients with moderate clinical severity, Hispanic ethnicity with LEP appears to be associated with lower imaging rates. This effect of English proficiency and Hispanic ethnicity warrants further investigation to understand and overcome barriers, which may lead to increased appendiceal perforation rates and differential diagnostic evaluation.Copyright © 2014 Elsevier Inc. All rights reserved.

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