(803) Delirium and Use of a Language Other Than English in the Pediatric Cardiac Intensive Care Unit

Introduction: There is a known relationship between language barriers and poorer healthcare outcomes in children. Delirium is a common complication among intensive care unit (ICU) patients. Family involvement on rounds and in patient care is recommended to help prevent delirium, but studies have shown suboptimal communication between families who use a language other than English (LOE) and the medical team. We hypothesized that use of an LOE would be associated with the presence of delirium.

Methods: This was a retrospective cohort study of patients admitted to the pediatric cardiac intensive care unit (PCICU) at a quaternary care children’s hospital from January 1, 2017 - July 31, 2023. Delirium was diagnosed via the Cornell Assessment of Pediatric Delirium (CAPD) score. Patients were divided into three language groups: English, Spanish, and languages other than English or Spanish (LOES). Covariates for analysis included known risk factors for delirium, like ICU length of stay, developmental delay, mechanical ventilation, use of physical restraints, and receipt of benzodiazepines, opiates, steroids, or vasoactive medications. We used a mixed-effects logistic regression model to analyze the association between delirium and language with covariates determined a priori.

Results: There were 2990 encounters and 1983 unique patients admitted to the PCICU during the study period. Of that group, 1865 patients (62.4%) received CAPD scores during their admission. Of the patients who received CAPD scoring, 1614 (86.5%) used English, 186 (10.0%) used Spanish, and 65 (3.5%) used an LOES. Delirium was present in 477 (25.6%) of patients with CAPD scores. Delirium was present in 413 (25.6%) of English-speakers, 51 (27.4%) of Spanish-speakers and 13 (20.0%) of the LOES group. After adjusting for covariates, there was not a statistically significant association between use of an LOE and delirium. Use of Spanish was associated with 1.43 times odds of delirium (95% CI (0.92, 2.22)), and use of a language other than English or Spanish was associated with 0.73 times odds of delirium (95% CI (0.33, 1.60)).

Conclusions: Although there was a higher prevalence of delirium among the Spanish speaking population, there was not an independent association between use of an LOE and delirium in PCICU patients.