Sociodemographic Factors are Associated with Care Delivery and Outcomes in Pediatric Severe Sepsis

Lece V Webb; Jakob Evans; Veronica Smith; Elisabeth Pettibone; Jarod Tofil; Jessica Floyd Hicks; Sherry Green; Ariann Nassel; Jeremy M Loberger

doi:10.1097/CCE.0000000000001056

Sociodemographic Factors are Associated with Care Delivery and Outcomes in Pediatric Severe Sepsis

Crit Care Explor. 2024 Feb 23;6(3):e1056. doi: 10.1097/CCE.0000000000001056. eCollection 2024 Mar.

Authors

Lece V Webb¹, Jakob Evans², Veronica Smith³, Elisabeth Pettibone³, Jarod Tofil⁴, Jessica Floyd Hicks⁵, Sherry Green⁵, Ariann Nassel⁶, Jeremy M Loberger¹

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
² Department of Pediatrics, Pediatrics Residency Program, University of Alabama at Birmingham, Birmingham, AL.
³ Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
⁴ University of Alabama, Tuscaloosa, AL.
⁵ Performance Improvement and Accreditation Department, Children's of Alabama, Birmingham, AL.
⁶ Lister Hill Center for Health Policy, School of Public Health, University of Alabama at Birmingham, AL.

Abstract

Importance: Sepsis is a leading cause of morbidity and mortality in the United States and disparate outcomes exist between racial/ethnic groups despite improvements in sepsis management. These observed differences are often related to social determinants of health (SDoH). Little is known about the role of SDoH on outcomes in pediatric sepsis.

Objective: This study examined the differences in care delivery and outcomes in children with severe sepsis based on race/ethnicity and neighborhood context (as measured by the social vulnerability index).

Design setting and participants: This retrospective, cross-sectional study was completed in a quaternary care children's hospital. Patients 18 years old or younger who were admitted between May 1, 2018, and February 28, 2022, met the improving pediatric sepsis outcomes (IPSO) collaborative definition for severe sepsis. Composite measures of social vulnerability, care delivery, and clinical outcomes were stratified by race/ethnicity.

Main outcomes and measures: The primary outcome of interest was admission to the PICU. Secondary outcomes were sepsis recognition and early goal-directed therapy (EGDT).

Results: A total of 967 children met the criteria for IPSO-defined severe sepsis, of whom 53.4% were White/non-Hispanic. Nearly half of the cohort (48.7%) required PICU admission. There was no difference in illness severity at PICU admission by race (1.01 vs. 1.1, p = 0.18). Non-White race/Hispanic ethnicity was independently associated with PICU admission (odds ratio [OR] 1.35 [1.01-1.8], p = 0.04). Although social vulnerability was not independently associated with PICU admission (OR 0.95 [0.59-1.53], p = 0.83), non-White children were significantly more likely to reside in vulnerable neighborhoods (0.66 vs. 0.38, p < 0.001). Non-White race was associated with lower sepsis recognition (87.8% vs. 93.6%, p = 0.002) and less EGDT compliance (35.7% vs. 42.8%, p = 0.024).

Conclusions and relevance: Non-White race/ethnicity was independently associated with PICU admission. Differences in care delivery were also identified. Prospective studies are needed to further investigate these findings.