Objective:

Assess the impact of language barriers on the evaluation of dizzy patients in the emergency department at a large academic hospital.

Background:

Dizziness is a nebulous chief complaint that requires a targeted history and examination to achieve accurate diagnoses and avoid unnecessary neuroimaging and hospital admissions. However, there are often barriers to obtaining a careful history in patients with Non-English language preference (NELP). NELP patients receive more diagnostic testing, are admitted more frequently, and are less satisfied with their care than patients with English language preference (ELP).

Design/Methods:

A retrospective review of adult patients presenting to the emergency department at a large academic center with an initial diagnosis of "dizziness and giddiness" was conducted. Patients who did not indicate a language preference or indicated American Sign Language were excluded. The primary outcomes analyzed were the rates of brain imaging, neurology consults, length of stay, and rate of admission. Statistical analyses were performed using R Studio.

Results:

Between January 2022 and August 2024, a total of 3,618 patients presented to the adult ED with dizziness. NELP patients received statistically significant higher rates of CT head and MRI brain imaging (46.4% and 21.8%, respectively) compared to ELP patients (34.7% and 18.5%, respectively; p<0.05). There were more neurology consults for NELP patients compared to ELP patients (17% versus 12.7%, respectively; p <0.01). NELP patients had longer average hospital stays (12 versus 10 hours; p<0.001) and higher rate of hospital admission (39% versus 31%; p<0.001) compared to ELP patients.

Conclusions:

Dizzy patients with NELP are subject to higher rates of imaging, neurology consults, longer hospital length of stay, and higher rate of hospital admission compared to ELP patients. Standardized protocols in the assessment of dizziness and appropriate language interpretation may reduce these disparities in care.