Presentation to Emergency Departments for Acute Rhinosinusitis: Disparities in Symptoms by Race and Insurance Status.

OBJECTIVE: Medicaid and self-pay insurance statuses and race are associated with emergency department (ED) presentation for uncomplicated acute rhinosinusitis (ARS). We investigated whether ARS symptomatology could explain this disproportionate ED use.

STUDY DESIGN: 2006-2010 National Hospital Ambulatory Medical Care Surveys.

SETTING: EDs in the United States.

SUBJECTS AND METHODS: The data comprise 1,632,826 adult visits for uncomplicated ARS at hospital EDs. Patient-reported reasons for presentation included constitutional symptoms, facial pain or headache, sinonasal symptoms, head cold or flu-like symptoms, cough or sputum production, and sore throat. Patient-reported pain level was also included. Symptoms were assessed for associations with insurance status and race after controlling for clinical, demographic, and socioeconomic characteristics.

RESULTS: Medicaid patients had similar symptomatology and levels of pain when compared with privately insured patients. Self-pay patients reported higher pain levels (P = .033) and were less likely to report head cold or flu-like symptoms (P = .018) but were equally likely to report other symptomatology. Relative to white patients, Hispanic patients were more likely to complain of facial pain and headaches (P = .033) and less likely to complain of other classical ARS symptoms, such as cough or sputum production (P = .013), sinonasal symptoms (P = .019), or head cold or flu-like symptoms (P = .019). Black patients were also less likely to complain of sinonasal symptoms (P = .038).

CONCLUSION: Symptomatology does not explain disproportionate ED use for ARS by Medicaid patients, while higher self-reported pain levels may explain self-pay patients' disproportionate ED utilization. Likewise, ED presentation for ARS among Hispanic patients may be related to symptomatology that is less specific for ARS, such as headache and facial pain.