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Language serves as a bridge between ideas and communication, influencing how individuals perceive and interact with the world. Psychologists have long debated whether language shapes thought or vice versa. This discussion gained grip with Edward Sapir and Benjamin Lee Whorf in the 1940s, who proposed that language determines thought, a concept known as linguistic determinism. They suggested that the vocabulary and structure of a language influence how its speakers think and perceive reality.
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Preferred Language and Race Impact Code Status in Critically Ill Children.

Stephanie Granada1, Michelle R Mayeda2, Jessica C Fowler2

  • 1Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.

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|December 18, 2024
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Children with non-English language preference (NELP) had higher odds of do not resuscitate (DNR) orders in the PICU, while Black patients had lower odds. These demographic factors significantly predict changes in code status.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Health Disparities Research
  • Clinical Outcomes Research

Background:

  • Limited research exists on the interplay between language preference, race, and code status decisions in Pediatric Intensive Care Units (PICUs).
  • Understanding these associations is crucial for addressing potential disparities in end-of-life care within diverse patient populations.

Purpose of the Study:

  • To investigate the association between non-English language preference (NELP) and race with the likelihood and timing of do not resuscitate (DNR) order placement in a PICU.
  • To identify demographic predictors of code status changes in critically ill children.

Main Methods:

  • A single-center retrospective cohort study included 45,143 PICU patients (January 2013-December 2022), excluding those with pre-existing DNR orders.
  • Logistic and Cox regression models analyzed the association of NELP and race/ethnicity with DNR order placement and time to DNR, adjusting for confounders like age and illness severity.

Main Results:

  • Patients with NELP (Spanish, Arabic, other) demonstrated significantly higher odds of DNR order placement compared to English-preference patients (aORs 1.81-3.59).
  • Patients with other NELP also experienced faster times to DNR placement (aHR 1.77).
  • Non-Hispanic Black patients had lower odds of DNR orders compared to non-Hispanic White patients (aOR 0.77).

Conclusions:

  • Non-English language preference is associated with increased odds and faster timing of DNR orders in the PICU.
  • Black race is a significant predictor of lower odds of DNR orders.
  • Demographic factors, including language preference and race, are critical determinants of code status changes and end-of-life care trajectories in the PICU, warranting further investigation into underlying mechanisms.