Preferred Language and Race Impact Code Status in Critically Ill Children.

IMPORTANCE

Few studies have assessed the relationships between language, race, and code status in a PICU.

OBJECTIVES

We aimed to identify whether non-English language preference (NELP) or race was associated with code status in a PICU.

DESIGN, SETTING, AND PARTICIPANTS: This was a single-center retrospective cohort study of 45,143 patients admitted to the PICU between January 2013 and December 2022, excluding those with pre-PICU do not resuscitate (DNR) orders.

MAIN OUTCOMES AND MEASURES

Two separate exposures were tested simultaneously (NELP and race/ethnicity) for association with the primary outcome of placement of a DNR order in the PICU (logistic regression). The secondary outcome was time to DNR order in patients in whom DNR orders were placed (Cox regression). Potential confounders were age, Pediatric Risk of Mortality III at 12 hours score, religion, admission diagnosis, and hospital length of stay before PICU admission.

RESULTS

Patients with Spanish-preference, Arabic-preference, or other NELP had higher odds of having a DNR order placed during PICU admission relative to English-preference (all adjusted odds ratios [aORs] between 1.81 and 3.59; all p < 0.001). Among patients with a DNR, Other NELP patients had faster times to DNR (adjusted hazard ratio, 1.77; 95% CI, 1.30-2.39; p < 0.001). Non-Hispanic Black patients consistently had lower odds of having a DNR order relative to non-Hispanic White patients (aOR, 0.77; 95% CI, 0.65-0.91; p = 0.002). Results were consistent in sensitivity analyses.

CONCLUSIONS AND RELEVANCE

Children with NELP had higher odds of having a new DNR order placed in the PICU, whereas non-Hispanic Black patients had lower odds. NELP may be correlated with unmeasured illness severity, thereby confounding the relationship between language and probability of DNR. However, our data support that demographic factors, such as Black race, are strong predictors of a change in code status to DNR and time to DNR.