V. Layrisse Landaeta1, G. Dincheva1, S. Khedr1, A. Geng1, A. Motta Burgos1, S. Chao1, C. Chen1,2 2Envision Healthcare, General Surgery, Nashville, TENNESSEE, USA 1New York Presbyterian Hospital, General Surgery, Queens, NY, USA
Introduction: In geriatric patients after falls, traumatic brain injury (TBI) severity is based on Glasgow Coma Scale (GCS) and neurobehavioral deficits after injury. Many variables have been studied in regards to TBI-related outcomes, however, the impact of English proficiency (EP) on TBI outcomes has not been well characterized. Because neurological assessment partly depends on language concordance, we hypothesize that patients with EP have different TBI related outcomes when compared with those with limited EP (LEP).
Methods: A retrospective review was performed at a Level I trauma center serving Flushing, NY, a populated multiethnic community. Patients aged ?65 years old presenting to the emergency department after a fall between January 1, 2018, and December 31, 2021, were included. Data was abstracted from the institution’s trauma registry. TBI was defined by relevant ICD-10 codes. Descriptive analysis was performed using Wilcoxon rank-sum test and Pearson’s chi-square test. Relationships between EP, GCS, and TBI were analyzed using both univariate and multivariable logistic regression.
Results: Of 6,841 patients meeting inclusion criteria, 2,842 (41.5%) were with LEP. In univariate analysis, GCS<15 was strongly correlated with TBI [OR 2.09, CI 1.79–2.43]. LEP patients had higher incidence of GCS<15 (21% vs 15%, p<0.001) and TBI (18% vs 13%, p<0.001). Patients with LEP were less likely to be activated as traumas compared to EP patients (28% vs 24%, p<0.001).
Comparing relevant demographics, we found LEP patients were predominantly Asian (71%); EP patients were predominately White (82%). LEP had lower insurance rates (87% vs 94%, p<0.001), higher rates of Abbreviated Injury Scale ≥ 2 (20% vs. 15%, p<0.001), higher rib fracture incidences (9.9% vs. 7.8%, p<0.002), and marginally lower rates of anticoagulant use on presentation (53% vs 56%, p=0.016). After accounting for demographic differences using multivariate analysis, LEP status was still predictive of GCS<15 but not of TBI. In a subgroup analysis, we found that Asians had a higher incidence of TBIs than other racial groups (21% vs. 12%, p<0.001). LEP status remained independently predictive of GCS < 15 but not TBIs in Asians and non-Asians.
Conclusion: In a multilingual community, our results show that having LEP is correlated with a higher incidence of GCS<15 and TBI. However, in multivariate analysis, LEP is independently predictive of GCS<15 but not TBI. The discrepancy may be attributable to race as a confounding variable, as Asians have higher incidences of TBI in our cohort. Within racial subgroups, LEP remains correlated with GCS < 15. Our results motivate further studies into race as a risk factor for TBI.
