(1579) Investigating Disparities in ICU Outcomes for Children of Families With Limited English Proficiency

Introduction: Children of families with limited English proficiency (LEP) face worse health outcomes than English proficient (EP) families. Ineffective communication is a crucial factor that can significantly impact outcomes for critically ill patients. Our aim was to investigate the difference in hospital course severity for critically ill pediatric patients in LEP families versus EP families.

Methods: This was a retrospective chart review of patients aged 2-17 years admitted to the PICU at a quaternary care children’s hospital diagnosed with sepsis from 2021 to 2023. We recorded preferred language, interpreter use, and demographics. PIM3 scores assessed hospital course severity, and we examined various hospital outcomes. Insurance status and Childhood Opportunity Index (COI) were proxies for social determinants of health (SDOH). We compared ICU and hospital length of stay (LOS), mechanical ventilation (MV), readmission, and hospital acquired conditions (HACs) between patients from LEP and EP families, using the Chi-square or Fisher’s Exact test for categorical variables and Wilcoxon rank-sum test for continuous variables, as appropriate.

Results: Records of 147 patients aged 2-17 years with sepsis diagnosis were analyzed. Of these, 16% were from LEP families, 7.5% expired and 5% were readmitted. Median (Q1-Q3) PIM3 scores for LEP families was 1.63 (0.83-3.79), and for EP families was 1.60 (1.04-3.90). Among patients with LEP, 60% had Medicaid, 25% had a COI of very high and 12.5% had a COI of very low.
Median (Q1-Q3) hospital and ICU LOS for LEP families were 10 (5-25) days and 4.5 (2-11) days, respectively. In LEP families, 50% needed MV, 38% required non-invasive MV, 0 were readmitted, and 8% had courses complicated by HACs. There was no significant difference in severity or length of hospital courses between LEP and EP families (p>0.05).

Conclusions: Critically ill children of LEP families did not have worse outcomes in our cohort, possibly because healthcare becomes more equitable when interpreter services are utilized. Limitations include disproportionate group size of LEP vs EP families and missing PIM3 scores. Future analyses will adjust for confounders and further analyze COI and insurance status effects on hospital outcomes in critically ill patients.