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Sociodemographic Factors are Associated with Care Delivery and Outcomes in Pediatric Severe Sepsis
Lece V Webb1, Jakob Evans2, Veronica Smith3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Insights
Racial and ethnic disparities impact pediatric severe sepsis outcomes. Non-White children faced higher intensive care unit admission rates and received less timely sepsis care, highlighting the need for further investigation.
Area of Science:
- Pediatric critical care medicine
- Health equity research
- Social determinants of health
Background:
- Sepsis significantly impacts pediatric morbidity and mortality in the U.S., with existing racial/ethnic disparities in outcomes.
- Social determinants of health (SDoH) are implicated in these disparities, but their specific role in pediatric sepsis is understudied.
Purpose of the Study:
- To investigate disparities in care delivery and outcomes for children with severe sepsis.
- To examine the influence of race/ethnicity and neighborhood socioeconomic context (social vulnerability index) on pediatric severe sepsis management and outcomes.
Main Methods:
- Retrospective, cross-sectional study of 967 pediatric patients meeting severe sepsis criteria (May 2018-Feb 2022).
- Analysis stratified by race/ethnicity and social vulnerability index.
- Primary outcome: Pediatric Intensive Care Unit (PICU) admission; Secondary outcomes: sepsis recognition and early goal-directed therapy (EGDT).
Main Results:
- Non-White race/Hispanic ethnicity was independently associated with increased PICU admission (OR 1.35).
- Non-White children were more likely to live in socially vulnerable neighborhoods (38% vs. 66%).
- Non-White race correlated with lower sepsis recognition rates and reduced EGDT compliance.
Conclusions:
- Non-White race/ethnicity is an independent risk factor for PICU admission in pediatric severe sepsis.
- Identified disparities in sepsis care delivery based on race/ethnicity.
- Further prospective research is warranted to explore these critical findings and inform interventions.
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.
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