Reporting of Social Determinants of Health in Pediatric Sepsis Studies*

Abstract

OBJECTIVE:Standardized, consistent reporting of social determinants of health (SDOH) in studies on children with sepsis would allow for: 1) understanding the association of SDOH with illness severity and outcomes, 2) comparing populations and extrapolating study results, and 3) identification of potentially modifiable socioeconomic factors for policy makers. We, therefore, sought to determine how frequently data on SDOH were reported, which factors were collected and how these factors were defined in studies of sepsis in children. DATA SOURCES AND SELECTION:We reviewed 106 articles (published between 2005 and 2020) utilized in a recent systematic review on physiologic criteria for pediatric sepsis.DATA EXTRACTION: Data were extracted by two reviewers on variables that fell within the World Health Organization's SDOH categories.DATA SYNTHESIS: SDOH were not the primary outcome in any of the included studies. Seventeen percent of articles (18/106) did not report on any SDOH, and a further 36.8% (39/106) only reported on gender/sex. Of the remaining 46.2% of articles, the most reported SDOH categories were preadmission nutritional status (35.8%, 38/106) and race/ethnicity (18.9%, 20/106). However, no two studies used the same definition of the variables reported within each of these categories. Six studies reported on socioeconomic status (3.8%, 6/106), including two from upper-middle-income and four from lower middle-income countries. Only three studies reported on parental education levels (2.8%, 3/106). No study reported on parental job security or structural conflict. CONCLUSIONS:We found overall low reporting of SDOH and marked variability in categorizations and definitions of SDOH variables. Consistent and standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development and severity of sepsis, to compare and extrapolate study results between settings and to implement policies aimed at improving socioeconomic conditions related to sepsis.

Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce

“…Social determinants of health (SDOH) in pediatric sepsis studies are not commonly reported, with marked variability in categorizations and definitions of SDOH variables. Standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development, progression, and recovery of sepsis, to implement policies aimed at addressing socioeconomic conditions related to sepsis (36). Actionable solutions to the considerations above are described in Table 1 and include individualized approaches dependent on setting, affordable diagnostics for accurate risk stratification, optimization of data capture from routinely collected datasets to support collaborative registries, and development of locally relevant outcome measures.…”

“…Social determinants of health (SDOH) in pediatric sepsis studies are not commonly reported, with marked variability in categorizations and definitions of SDOH variables. Standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development, progression, and recovery of sepsis, to implement policies aimed at addressing socioeconomic conditions related to sepsis ( 36 ).…”

Editor’s Choice Articles for April

“…This month’s special topic for reading review is the recent material PCCM has published on SDOH. Begin with this month’s secondary analysis of a systematic review on physiologic criteria for pediatric sepsis (19): the authors from the Pediatric Sepsis Definition Taskforce reviewed 106 papers and present their prior findings in relation to the World Health Organization SDOH categories. The accompanying editorial is a landmark publication in my view–please read (20).…”

Editor’s Choice Articles for June

“…This month’s special topic for educational review is management of severe illness in resource-limited settings. Start with this month’s Special Article about operationalizing appropriate sepsis definitions in children, worldwide, with an emphasis on low- and middle-income (LMIC) settings (18); the article comes from the Society of Critical Care Medicine Pediatric Sepsis Definition Taskforce (19, 20). Follow this introduction to sepsis practice in LMIC settings by reviewing two reports from PCCM 2021 about severity of illness.…”