Abstract Rationale 26 million individuals in the United States have limited English proficiency (LEP). Given the impact communication has on clinical assessments and outcomes in intensive care units (ICU), patients with LEP may be at particular risk for suboptimal intensive care. Though LEP has been associated with worse patient-centered and process metrics in the ICU, its effect on overall clinical outcomes is less clear. The objective of this study was to evaluate the impact of LEP on ICU length of stay (LOS) in a single medical ICU (MICU), which serves a population where 18.5% have LEP. Methods We conducted a retrospective, observational cohort study based on electronic health record (EHR) data on patients admitted to the MICU at a safety-net hospital serving Dallas County, Texas from January 2021-December 2024. All patients admitted to the MICU during this time frame were included. Patients with LEP were defined as patients that had indicated a preferred language other than English in the EHR (final analysis included Spanish-speaking patients only). Non-LEP was defined as English preferred language recorded in the EHR. The primary outcome was length of ICU stay. Secondary outcomes included survival to hospital discharge. Results 6,231 patients were included in the study sample of which 39% (n = 2431) had LEP. Patients with LEP were on average older (55 vs. 52, p 0.001) and had a higher case mix index than non-LEP patients (3.50 vs. 3.19, p 0.001). The LEP group had a higher proportion of patients with end stage renal disease (15% vs. 11%, p 0.001) and chronic liver disease (42% vs 34%, p 0.001), while the non-LEP group had a higher proportion of patients with congestive heart failure (38% vs. 33%, p 0.001), chronic pulmonary disease (34% vs. 17%, p 0.001), and HIV (6.5% vs. 2.5%, p 0.001). There was no difference in mean ICU LOS between LEP and non-LEP groups (3.84 vs. 3.26, p = 0.444). However, LEP was associated with decreased survival to hospital discharge (80% vs. 77% alive at hospital discharge, p 0.001). Conclusions LEP is associated with decreased survival to hospital discharge in the MICU, though it does not appear to impact ICU LOS. Strengths of our study include our large sample of patients with LEP, though our findings may be limited by differences in baseline clinical status of study populations. Our group also plans to conduct additional analysis via multivariable regression or propensity-score matching between these cohorts to assess if this association persists when accounting for baseline comorbidities. This abstract is funded by: None
Krishnan et al. (2026) studied this question.