(112) Association Between Medical Complexity and Preferred Language in the Pediatric Intensive Care Unit

Introduction: Children from families who use a language other than English (LOE) face barriers to equitable care. Among children admitted to the hospital, children in families who use an LOE are more likely to have technology dependence than English-speaking patients. Technology dependence is common among children with medical complexity (CMC). We hypothesized that in the PICU, use of an LOE is associated with medical complexity and that use of an LOE in the CMC population will have a negative effect on outcomes.

Methods: This was a single-site retrospective cohort study of encounters from 9/1/2017-8/31/2022. CMC were defined as having at least 3 chronic conditions or technology dependence. We performed univariate and multivariate analyses between demographic factors and the presence of medical complexity. Secondary outcomes included initial illness severity, the number of ventilator free days at 28 days, number of organ dysfunction free days at 28 days, PICU LOS, total hospital LOS, total hospital charges (cost), and in-hospital mortality. Differences in secondary outcome measures by language preference and medical complexity were modeled using series of mixed-effects regression models.

Results: There were 6,802 unique patients with 10,011 total encounters. A total of 5,199 encounters (51.9%) were for CMC and 1433 (14.3%) encounters were for patients from families who use LOE. In multivariate analysis, Spanish LOE (aOR 1.29, 95% CI (1.11, 1.49)) and non-Spanish LOE (aOR 1.36, 95% CI (1.02, 1.80)) were independently associated with medical complexity. In adjusted models, CMC in households who used a non-Spanish LOE had fewer organ dysfunction-free days (p = 0.003), PICU length of stay was 1.53 times longer (95% CI (1.10, 2.13)), total hospital stay was 1.45 times longer (95% CI (1.11, 1.91)), and total cost was 2.89 times higher (95% CI (1.78, 4.67)) compared to CMC who used English. There were not significant differences in outcomes for the Spanish LOE group compared to English for organ dysfunction, ventilator-free days, LOS, and cost.

Conclusions: Use of LOE was independently associated with increased medical complexity. Among the CMC population, use of non-Spanish LOE was associated with worse outcomes. Further research to better characterize and reduce this difference in outcomes is necessary.