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Impact of Race and Ethnicity, Income, Language, and Insurance on Timeliness of Pediatric Emergency Department Sepsis
Lina Ha1, Lynne Fullerton2, Kjirsten Swenson3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
Insights
This study found no significant differences in sepsis care timeliness based on race, ethnicity, income, or insurance. However, longer emergency department stays were observed for patients preferring languages other than English.
Area of Science:
- Pediatric Emergency Medicine
- Sepsis Care Research
- Health Equity Studies
Background:
- Sepsis care quality can be influenced by patient demographics.
- Understanding disparities in pediatric sepsis care is crucial for improving outcomes.
Purpose of the Study:
- To assess the association between demographic factors (race, ethnicity, language, income, insurance) and sepsis care processes/outcomes in a pediatric emergency department (PED).
Main Methods:
- Retrospective cohort study of children (2 months to <18 years) with sepsis in a tertiary-care children's hospital PED.
- Data collected from July 2020 to July 2023, including time to fluid bolus, antibiotics, and length of stay (LOS).
- Analysis focused on associations between demographic variables and sepsis care metrics.
Main Results:
- No significant differences in time to sepsis interventions (fluids, antibiotics) were found across studied demographic groups.
- Patients preferring languages other than English had a significantly longer PED LOS (350 min) compared to English speakers (245 min).
- No other significant differences in PED or hospital LOS were observed based on demographic factors.
Conclusions:
- Demographic factors like race, ethnicity, income, and insurance status were not associated with timely sepsis interventions.
- Preferred language was linked to a longer PED LOS, suggesting potential communication or systemic barriers.
- The lack of broader disparities may be context-specific; further research is needed on care processes and intervention barriers.
Objective:
This study aimed to measure the association of race and ethnicity, preferred language, income, and insurance status on process and outcomes measures of sepsis care in a pediatric emergency department (PED).
Methods:
A single-center, retrospective cohort study was conducted at the only tertiary-care children's urban hospital with a PED in New Mexico. Children aged 2 months to younger than 18 years old who were evaluated in the PED from July 2020 to July 2023 and met sepsis criteria by ICD-10 codes were screened for inclusion. Demographic data and outcomes including median time to fluid bolus, time to antibiotics, PED length of stay (LOS), and hospital LOS were collected from the electronic medical records.
Results:
There was no significant difference in time to sepsis interventions by demographic factors studied. Patients who reported preferring a language other than English had longer PED LOS (350 min, P = 0.024) compared with English speakers (245 min), but there were no other significant differences in PED and hospital LOS by demographic factors.
Conclusions:
There were no associations between race and ethnicity, income, preferred language, insurance status, and time to sepsis interventions. PED LOS was significantly different by reported preferred language. This overall lack of differences may be attributed to the local context of the study, which may not be generalizable to other areas. Further research is warranted to investigate processes that lead to similar care and barriers to timely interventions.
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