(333) Association Between Language, Medical Complexity, and PICU Admission in Acute Respiratory Illness

Introduction: Children with medical complexity (CMC) are at greater risk for hospitalization and PICU admission compared to the general pediatric population. Children of families speaking languages other than English (LOE) have worse outcomes during hospitalization, including higher odds of PICU transfer. We hypothesized that CMC of LOE speaking families would be at increased risk of PICU admission during hospitalization for acute respiratory illness compared to CMC of English-speaking families.

Methods: This was a retrospective cohort analysis of CMC < 18 years old admitted to an urban quaternary pediatric hospital with acute respiratory illness from June 2015 to May 2022. CMC were defined using the Complex Chronic Conditions list (CCC) with conditions in at least 2 body systems or technology dependence. Patient sociodemographic (language, race, insurance status) and clinical data were extracted from the medical record. Associations were tested in R with binomial mixed effect regression. The primary outcome was PICU admission and primary exposure was language.

Results: We identified 939 encounters; 326 unique CMC patients were included in the analysis. Mean age was 4.46 years (SD: 4.95); 20.5% identified as Black or African American, 70.9% White, 3.1% Asian and 7.1% Hispanic. In the cohort, 7.1% of patients’ primary language was not English, with 3.7% Spanish and 3.4% language other than English or Spanish (LOES). Technology dependence was present in 74.5% of patients. During the study period, 38% of patients had a PICU admission. In the basic model with binary outcome, PICU admission, the coefficient for LOE was 1.36 (OR, 3.89; 95% CI, 0.95-15.9). In models adjusted for race, age, and public insurance, the coefficient for LOE was 1.73 (OR, 5.63; 95% CI, 1.1-28.3). In adjusted model with Spanish and LOES, Spanish was not significant and LOES coefficient was 2.49 (OR, 12.1; 95% CI, 1.1-140).

Conclusions: We found a strong association between LOE and PICU admissions among the CMC population with acute respiratory illness. This association was driven by the LOES subgroup. These results may guide healthcare delivery strategies for LOES families, including barrier evaluation and enhancement of language resources. These interventions have the potential to mitigate disparities for all pediatric patients.