Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians' implicit bias.

1. Solé D, Wandalsen GF, Camelo-Nunes IC, et al. Prevalência de sintomas de asma, rinite e eczema atópico entre crianças e adolescentes brasileiros identificados pelo International Study of Asthma and Allergies in Childhood (ISAAC) -Fase 3. J Pediatr. 2006;82:341-346. 2. Thijs JL, Strickland I, Bruijnzeel-Koomen C, et al. Moving toward endotypes in atopic dermatitis: Identification of patient clusters based on serum biomarkers analysis. J Allergy Clin Immunol. 2017;140:730-737. 3. Laske N, Niggemann B. Does the severity of atopic dermatitis correlate with serum IgE levels? Pediatr Allergy Immunol. 2004;15:86-88. 4. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venerol. 1980;92:44-47. 5. European Task Force on Atopic Dermatitis. Severity scoring of atopic dermatitis: the SCORAD Index (consensus report of the European Task Force on Atopic Dermatitis). Dermatology. 1993;186:23-31.

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Objectives: High Vasoactive-Inotropic Scores have demonstrated association with poor outcomes in pediatric cardiac ICUs and are being calculated more frequently in studies of critically ill noncardiac patients. Available studies differ in their approach to assigning Vasoactive-Inotropic Scores, making direct comparisons difficult. The goal of this investigation is to compare multiple approaches to Vasoactive-Inotropic Score assignment to determine their strength of association with mortality in a general pediatric intensive care population. In doing so, we aim to help validate the use of the Vasoactive-Inotropic Score in noncardiac patients and to help inform future studies of the relative strength of available approaches in assigning this score. Design: Retrospective chart review. Setting: PICU at an academic freestanding children’s hospital. Patients: Two-thousand seven-hundred fifty-two consecutive patients admitted over a 17-month time period were screened for receiving inotrope or vasopressor therapies regardless of disease process. Four-hundred seventy-four patients met inclusion criteria. Interventions: None. Measurements and Main Results: For each patient treated with continuous infusions of vasoactive medications, a Vasoactive-Inotropic Score was calculated (and then recalculated) every time they had a documented dose change. Multiple strategies were evaluated to generate receiver operating characteristic curves in relation to mortality. Area under the curve was greatest when evaluating the maximum Vasoactive-Inotropic Score (Max Any) during the initial treatment course (0.788) with an increasing relative risk as the score increased. The Vasoactive-Inotropic Score at 48 hours after treatment initiation had next highest area under the curve (0.736). Primary diagnosis categories were also analyzed, and area under the curve was greatest for the cardiovascular group (0.879). Conclusions: Increasing Vasoactive-Inotropic Scores for patients in the PICU are associated with mortality risk. The scoring strategy used can influence the strength of the association, as can the primary diagnosis category.