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

Hunter Hamilton; Alina N West; Nariman Ammar; Lokesh Chinthala; Fatma Gunturkun; Tamekia Jones; Arash Shaban-Nejad; Samir H Shah

doi:10.3389/fpubh.2022.789999

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

Front Public Health. 2022 Apr 29:10:789999. doi: 10.3389/fpubh.2022.789999. eCollection 2022.

Authors

Hunter Hamilton¹, Alina N West¹, Nariman Ammar², Lokesh Chinthala³, Fatma Gunturkun², Tamekia Jones^{4

5}, Arash Shaban-Nejad², Samir H Shah¹

Affiliations

¹ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States.
² University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States.
³ Clinical Trials Network of Tennessee, University of Tennessee Health Science Center, Memphis, TN, United States.
⁴ Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States.
⁵ Children's Foundation Research Institute Biostatistics Core, Memphis, TN, United States.

Abstract

Objectives: Of 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.

Methods: This 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.

Results: 83 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.

Conclusion: Pediatric 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.

Keywords: children with medical complexity; health disparities; pediatric intensive care unit; severe sepsis; social determinants of health.

Publication types

Observational Study

MeSH terms

Child
Child, Preschool
Critical Illness
Female
Humans
Infant
Intensive Care Units, Pediatric
Length of Stay
Male
Sepsis* / epidemiology
Social Determinants of Health*