Analyzing Relationships Between Economic and Neighborhood-Related Social Determinants of Health and Intensive Care Unit Length of Stay for Critically Ill Children With Medical Complexity Presenting With Severe Sepsis

Abstract

ObjectivesOf the Social Determinants of Health (SDoH), we evaluated socioeconomic and neighborhood-related factors which may affect children with medical complexity (CMC) admitted to a Pediatric Intensive Care Unit (PICU) in Shelby County, Tennessee with severe sepsis and their association with PICU length of stay (LOS). We hypothesized that census tract-level socioeconomic and neighborhood factors were associated with prolonged PICU LOS in CMC admitted with severe sepsis in the underserved community.MethodsThis single-center retrospective observational study included CMC living in Shelby County, Tennessee admitted to the ICU with severe sepsis over an 18-month period. Severe sepsis CMC patients were identified using an existing algorithm incorporated into the electronic medical record at a freestanding children's hospital. SDoH information was collected and analyzed using patient records and publicly available census-tract level data, with ICU length of stay as the primary outcome.Results83 encounters representing 73 patients were included in the analysis. The median PICU LOS was 9.04 days (IQR 3.99–20.35). The population was 53% male with a median age of 4.1 years (IQR 1.96–12.02). There were 57 Black/African American patients (68.7%) and 85.5% had public insurance. Based on census tract-level data, about half (49.4%) of the CMC severe sepsis population lived in census tracts classified as suffering from high social vulnerability. There were no statistically significant relationships between any socioeconomic and neighborhood level factors and PICU LOS.ConclusionPediatric CMC severe sepsis patients admitted to the PICU do not have prolonged lengths of ICU stay related to socioeconomic and neighborhood-level SDoH at our center. A larger sample with the use of individual-level screening would need to be evaluated for associations between social determinants of health and PICU outcomes of these patients.

Association of the social disorganization index with time to first septic shock event in children with acute myeloid leukemia

“…One study found no significant association between neighborhood social vulnerability and prolonged lengths of intensive care unit stays for children with severe sepsis and underlying medical complexity, not restricted to patients with cancer. 41 Nationally, roughly 80% of pediatric patients with AML receive care in the inpatient setting. 42 Therefore, we assume that most of our population of patients with AML was already admitted to the hospital after receipt of chemotherapy.…”

“…The general pediatric literature has mixed findings on the association of area‐based measures of SDOH and infection‐related outcomes, including sepsis. One study found no significant association between neighborhood social vulnerability and prolonged lengths of intensive care unit stays for children with severe sepsis and underlying medical complexity, not restricted to patients with cancer 41 . Nationally, roughly 80% of pediatric patients with AML receive care in the inpatient setting 42 .…”

A Multicenter Retrospective Evaluation of Social Determinant of Health Z Code Usage among Pediatric Patients with Critical Care Visits during Pediatric Critical Care

“…13,14 Thus, coding SDOH through ICD-10 Z codes when the patient receives pediatric critical care can assist in quality improvements and providing appropriate resources in the pediatric intensive care unit (PICU) setting to improve patient outcomes, decrease the length of stay, decrease medical resource utilization, and prevent readmission. 9,15,16 Despite a known association between SDOH and PICU admission in single-center studies, 17 there are no specific data on the prevalence of screening and tracking of SDOH in critically ill pediatric populations. Our study aims to examine how SDOH Z codes are utilized in the pediatric critical care setting in a multicenter fashion hypothesizing that based on the current literature, 9,10 a minority of pediatric patients who are billed to have received critical care services will have a SDOH code present.…”