Children From Families Speaking Languages Other Than English or Spanish, Medical Complexity and PICU Utilization: Single-Center Retrospective Study, 2015–2022

Objectives: Children with medical complexity (CMC) account for a disproportionate share of PICU utilization. Children from families speaking languages other than English (LOE) face barriers that may influence critical-care needs. We sought to evaluate the intersection of language and PICU utilization of CMC. Design: Retrospective cohort study. Setting: Large quaternary children’s hospital in the United States, from 2015 to 2022. Patients: CMC, defined as having two or more body systems involved in a complex chronic condition (CCC), admitted to a children’s hospital. Patient family language categorized as English, Spanish, or languages other than English or Spanish (LOES). Interventions: None. Measurements and Main Results: We identified 3096 unique CMC (54% male) accounting for 9297 hospital encounters (mean age 8.2 yr). Among patient families, 7.2% had a preferred LOE, with 2.7% speaking Spanish and 4.6% speaking LOES. Around one-third (35%) of patients had a PICU admission during at least one encounter. Mixed-effects regressions with patient-specific random effects were used to model associations. LOES was associated with greater odds of PICU admission (adjusted odds ratio 1.58; 95% CI, 1.1–2.2) and longer PICU length of stay (incidence-rate ratio 2.4; 95% CI, 1.7–3.5) after adjusting for age, sex, race, Child Opportunity Index (COI) and the number of CCC. Conclusions: In patients admitted to our children’s hospital (2015–2022), the CMC from families speaking a LOES represented a vulnerable subgroup, with associated greater odds of PICU admission and longer stays. These disparities persisted after accounting for CCCs and COI. Timely, language-concordant communication—especially for less common languages–may mitigate aspects of critical care admission in this population.