(821) Association of Language Preference on Delirium Screening and Prevalence in Pediatric Critical Care

Introduction: Delirium is well described in pediatric intensive care units (ICUs), and is associated with increased costs and length of stay. Known risk factors are age, sedation use, and illness severity, with less known about the impact of social determinants of health. Given the increase in non-English language preference (NELP) households, we evaluated the relationship between language preference and delirium. We hypothesized patients with a NELP were more likely to be delirious and less likely to be screened for delirium.

Methods: A retrospective review of a delirium dataset at a single tertiary care center from January 2022 to June 2023. The dataset comprised 2,082 patients with 23,447 unique observation points for delirium assessment using the Cornell Assessment of Pediatric Delirium (CAPD) tool. All statistical tests were performed using SAS version 9.4. Descriptive analysis was performed for demographic characteristics, including language preference, race, sex, age, and ICU type. At patient level, the mean number of CAPD performed and screen positive for delirium were compared by the characteristics using a generalized linear model and chi-square test. At observation level, the adjusted odds ratios (Adj ORs) of CAPD performance and screen positive delirium after controlling for sex, age, and ICU type were estimated using generalized estimating equations (GEEs) incorporating correlation within-subject across shifts.

Results: Average delirium screening compliance was 46%. Language preference was predominantly English (1758 (84.7%)) and Spanish (250 (12%)), with 68 patients (3.3%) speaking a total of 19 other languages. Patients with Spanish language preference were more likely to have both the CAPD performed (Adj. OR= 1.34, 95% CI= [1.25, 1.43]) and screen positive for delirium (Adj. OR=1.71, 95% CI=[1.56, 1.87]) compared to those with English preference (EP). Children from non-Spanish NELP households were also more likely to have CAPD screening (Adj. OR=1.33, 95% CI=[1.18, 1.49]), though they were not found to have significantly higher delirium rates than EP patients (Adj. OR=0.94, 95% CI=[0.78, 1.13

Conclusions: NELP patients were more likely to be screened for delirium than EP patients. Spanish language preference was associated with an increased risk of positive delirium screening.