(856) Non-English Language Preference, Race, and Code Status in the Pediatric Intensive Care Unit

Introduction: Few studies have identified the relationships between language, race, and code status in the pediatric intensive care unit (PICU). Studies in adults show that patients with non-English language preferences (NELP) are less likely to have a do not resuscitate (DNR) order during their ICU admission. Additionally, there has been limited research focusing on the connection between race and code status in the PICU. Therefore, we aimed to identify whether NELP or race was associated with code status in the PICU.

Methods: A single-center retrospective cohort study of patients admitted to the PICU at the Children’s Hospital of Philadelphia between 01/2013 and 12/2022, excluding those with pre-PICU DNR orders. NELP (Spanish, Arabic, Other) and race (non-Hispanic White, non-Hispanic Black, Hispanic, Other) were separately tested for association with probability of DNR order using logistic regression. In those with DNR orders, NELP and race were tested for time to placement of DNR using Cox regression. All analyses were adjusted for age, Pediatric Risk of Mortality [PRISM] 3 score, religion, and length of stay before PICU admission.

Results: Of 45,143 eligible subjects, 83% had English as a preferred language, 8% reported NELP, and 9% were missing a language preference. A plurality of subjects (44%) identified as non-Hispanic White, 26% as non-Hispanic Black, 15% as Hispanic, and 15% as “Other.” Patients with NELP were more likely to have DNR orders (all adjusted OR between 1.8 and 4.4; all p< 0.001). Black patients were less likely to have a DNR order (aOR 0.79; 95%CI 0.67-0.94; p=0.006). DNR orders were placed faster in Other (not Spanish or Arabic) NELP subjects (aHR 1.83; 95%CI 1.37-2.43; p< 0.001). Conversely, Black subjects had a longer delay between PICU admission and DNR order (aHR 0.83; 95%CI 0.70-0.99; p=0.038).

Conclusions: In a single center cohort from Philadelphia, children with NELP had higher odds of DNR orders placed in the PICU. Having a NELP may be correlated with severity of illness, thereby confounding the relationship between language and probability of DNR. Our data suggests that other factors, such as Black race, may be a stronger predictor of whether a patient is made DNR, as well as time to DNR.