(1589) Sepsis Management and Outcomes in Children With a Language for Care Other Than English

Introduction: History from caregivers is an important aspect of identifying children with sepsis. Patients with a language other than English (LOE) for medical care may thus experience disparities in sepsis care. We evaluated associations between language with sepsis processes of care and outcomes, hypothesizing that patients with a LOE would experience delays in sepsis recognition and management, longer hospitalizations, and higher mortality.

Methods: We conducted a retrospective cohort study of children aged 0-17 years at Seattle Children’s Hospital from 2015 to 2023 with sepsis recognition (positive screen or treatment initiation) during their emergency department (ED) or inpatient stay. We used Chi square and Wilcoxon rank-sum tests to compare automated vital sign- and laboratory-based sepsis screening scores, sepsis recognition, management, and outcomes between patients with English language for care vs LOE.

Results: Of 4550 patients, 14.1% had a LOE, most commonly Spanish (8.3%). The location of sepsis recognition was similar by language (ED 63.2%, ward 12.4%, ICU 24.4%). Patients with a LOE had lower initial risk for sepsis based on sepsis screen scores (median 6.3 vs 6.6, p=0.05). ED patients with a LOE had a non-significantly longer time from ED triage to sepsis activation (median 47 vs 40 min, p = 0.29) despite similar ED acuity scores. Median time from sepsis activation to antibiotic and blood culture orders were similar for LOE patients in the ED (antibiotic 50 vs 48 min; culture 55 vs 36 min), and slightly but non-significantly longer for LOE patients on the hospital ward (antibiotic 167 vs 60 min, p=0.09; culture 325 vs 277 min, p=0.46). Median time from antibiotic order to administration was longer in the ICU for patients with a LOE (79 vs 68 min, p=0.05). Patients with sepsis with a LOE had longer hospital stays (30 vs 26 days, p=0.02) and higher 30-day all-cause mortality (6.7% vs 5.2%, p=0.1).

Conclusions: Children with a language other than English for care are at risk for experiencing delayed diagnosis of sepsis, longer processes of care, longer hospital stays, and higher mortality rate despite lower initial sepsis risk. Efforts to improve pediatric sepsis management should include focus on interpreter access and equitable care for all language groups across ED, ward, and ICU settings.