(832) Effect of Language on Pediatric Rapid Response Activation: Single-Center Retrospective Cohort Study

Introduction: Studies have shown higher medical complexity and longer length of stay (LOS) for children of marginalized race and ethnicity. A rapid response (RR) may be activated when patients have increased acuity. No studies exist on the effect of language on time to RR and subsequent intensive care utilization.

Methods: The primary outcome of this single-center retrospective cohort study of pediatric patients with RR activation admitted from January 2020 to June 2023 was association between language and time to RR. Secondary outcomes were Pediatric Early Warning Signs (PEWS) score, ICU utilization, and LOS. Univariable linear regression model with log-transformed time to RR was used to determine difference between English-speaking and language other than English (LOE) groups. To detect a 4-hour difference, 209 patients were required (1-β =0.995). The Chi-square test was used to compare mechanical ventilation (MV), non-invasive ventilation (NIV), and inotropic support (IS). An independent-sample-t-test was used for LOS.

Results: 432 RR activations occurred with 374 unique patients. Of which, 280 (75.0%) were English-speaking, and 94 (25%) LOE. There was no difference in time to RR activation for English-speakers and LOE patients [26.4 h (IQR 8.7, 73.4) vs 27.4 h (IQR 5.1, 116.2), p =0.5819]. The PEWS score was equivalent for all languages (2.0, p =0.5888), but Spanish speakers had a higher rate of ICU transfer compared to English-speaking patients (59.7% vs. 43.9%), whereas other-language speakers had a lower rate (22.7%), p=0.0047. LOE patients were more likely to have RR activation due to a SIRS alert than English-speakers (34.6% vs 25.7%). LOE patients had a positive trend for MV (22.2% vs 5.3%, p=0.0769), NIV (72.2% vs 50.0%, p=0.1532), and IS (16.7% vs 2.6%, p=0.0928) and had a 3-day stay prolongation compared to English-speakers [10.0 (4.0, 26.0) vs 7.0 (4.0, 15.0), p = 0.0425].

Conclusions: Time to RR was similar for all languages. However, Spanish-speaking patients had a higher ICU transfer rate, suggesting a delay in RR activation. LOE patients had prolonged LOS and potentially higher ICU utilization, highlighting the need for improved language concordance and accessibility. Future studies will evaluate interpreter use and degree of language proficiency.