Language barriers are associated with worse outcomes in pediatric foreign body aspiration: A national cohort study

Foreign body aspiration (FBA) is a serious and potentially life-threatening pediatric emergency. When promptly diagnosed and managed, outcomes are usually favorable, but delayed recognition can result in pneumonia, acute respiratory distress and even death. Prior studies show that language barriers and limited English proficiency (LEP) are associated with delayed diagnosis, increased risk of high-severity aspirations (e.g., nuts), and disparities in perioperative and emergency care. However, few investigations have directly examined the relationship between language barriers and clinical outcomes in pediatric FBA. This study sought to evaluate these associations in a large national cohort.

We conducted a retrospective cohort study using the TriNetX research network. Pediatric patients (<18 years) with an index diagnosis of FBA were included. Exclusion criteria were age ≥18, prior history of FBA, asthma, or neuromuscular disorders. Two cohorts were created: children with FBA and a documented ICD code for acculturation difficulty (language barrier group) and children with FBA without such documentation (control group). Summary statistics were generated, and cohorts were propensity matched via multivariate linear regression based on age, age at index event, gender, race, and ethnicity. Outcomes compared included pneumonia, bronchoscopy, prolonged hospital stay, chest radiograph utilization, acute respiratory distress, dyspnea, and critical care services.

After propensity score matching for age, age at index event, sex, race, and ethnicity, 880 pediatric patients with foreign body aspiration (FBA) and documented language barriers were compared with 880 matched controls. Patients with language barriers experienced significantly higher rates of pneumonia (39.0% vs 21.8%; OR 2.29, 95% CI 1.86-2.82; p < 0.0001) and prolonged hospital stay (6.93% vs 2.16%; OR 3.38, 95% CI 2.00-5.70; p < 0.0001). Respiratory complications were also more common, including acute respiratory distress (8.64% vs 1.93%; OR 4.80, 95% CI 2.81-8.19; p < 0.0001) and dyspnea (13.1% vs 3.86%; OR 3.74, 95% CI 2.52-5.55; p < 0.0001). Chest radiograph utilization (26.5% vs 14.0%; OR 2.22, 95% CI 1.74-2.82; p < 0.0001) and critical care use (6.93% vs 2.05%; OR 3.57, 95% CI 2.09-6.09; p < 0.0001) were higher among language barrier patients, while bronchoscopy rates were similar between groups (4.21% vs 3.30%; OR 1.29, 95% CI 0.79-2.11; p = 0.32).

This national analysis demonstrates that pediatric patients with language barriers face significantly higher morbidity and resource utilization following FBA. These findings reinforce evidence that LEP contributes to delayed recognition, higher complication rates, and disparities in perioperative and emergency care. In the context of FBA, where timely diagnosis is critical, language barriers may affect survival and recovery. Standardized use of professional interpreters and culturally tailored caregiver education represent actionable strategies to reduce these inequities and potentially improve outcomes in this vulnerable population. To our knowledge, this is the first large-scale national study to directly examine language barriers and pediatric FBA outcomes.