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Clinical correlations with unmet social needs in critically ill children with asthma
Scott E Call1, Lisa Goto1, Gwynne Latimer1,2
1Department of Critical Care Medicine, Children's National Hospital, Washington, DC.
Insights
Unmet social needs significantly impact critically ill children with asthma, leading to longer hospital stays and increased emergency care visits. Addressing these needs can improve outcomes for this vulnerable pediatric population.
Area of Science:
- Pediatric critical care medicine
- Social determinants of health
- Asthma management
Background:
- Social drivers of health are crucial for pediatric asthma outcomes.
- The impact of family-level unmet social needs on critically ill pediatric asthma patients remains understudied.
Purpose of the Study:
- To investigate the association between unmet social needs at pediatric intensive care unit (ICU) admission and patient outcomes.
- To determine if unmet social needs correlate with ICU-related and post-ICU care utilization.
Main Methods:
- A 12-month prospective cohort study screened families of pediatric asthma patients admitted to the ICU.
- Unmet social needs across multiple domains were assessed.
- Regression analyses correlated unmet needs with clinical outcomes like length of stay, need for respiratory support, and re-admission rates.
Main Results:
- 57% of screened families reported at least one unmet social need.
- Unmet needs were linked to longer hospitalizations and a higher likelihood of emergency department visits.
- Intervention led to a reduction in reported unmet needs at follow-up.
Conclusions:
- Critically ill pediatric asthma patients face high rates of unmet social needs.
- These needs are associated with adverse outcomes, including prolonged hospital stays and recurrent emergency care.
- Identifying and supporting these families offers a chance to improve care through targeted interventions.
Background:
Social drivers of health have been implicated as playing a major role in determining pediatric asthma outcomes. However, the impact of self-reported, family-level unmet social needs on asthma outcomes in critically ill pediatric patients is unknown.
Objective:
Our aim was to determine whether the presence of unmet social needs at the time of intensive care unit (ICU) admission are associated with ICU-related and postadmission outcomes.
Methods:
This was a 12-month (February 2022-January 2023) prospective cohort study at a single, urban pediatric health care system. Families of patients admitted to the pediatric ICU for asthma were screened for unmet social needs in multiple domains. Regression analyses were performed to correlate unmet needs with the following clinical outcomes: duration of bilevel positive airway pressure use; lengths of ICU and hospital stay; and rates of 6-month outpatient follow-up, ED visitation, and hospital readmission.
Results:
Of 164 screened families, 57% reported at least 1 unmet social need. Unmet needs were significantly associated with longer hospitalizations (ie, a 3% increase per year of age (odds ratio =1.03 [95% CI = 1.00-1.07]) and a higher likelihood of returning for emergency care (adds ratio =2.6 [95% CI = 1.1-6.2]), even after accounting for race, insurance payer, and medical comorbidities. Additionally, patients provided with resources reported fewer needs when rescreened at outpatient follow-up (median = -1 need [P = .001]).
Conclusion:
Families of critically ill pediatric patients with asthma reported a high rate of unmet social needs. Furthermore, those with needs were vulnerable to longer stays and repeat asthma exacerbations requiring emergency care. Identification of these families presents an opportunity to target a high-risk population with durable medical and social interventions.
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