Alina West, MD, PhD
Scientist Physician
University of Tennessee Health Science Center
Memphis, Tennessee
Disclosure information not submitted.
Hunter Hamilton, BS, MD
University of Tennessee Le Bonheur Children's Hospital
Memphis
Disclosure information not submitted.
Nariman Ammar, PhD
Postdoctoral Scholar
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Fatma Gunturkun (she/her/hers)
PhD
Le Bonheur Children's Hospital
Palo Alto, California, United States
Disclosure information not submitted.
Tamekia Jones, PhD
Associate Professor
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Lokesh Chinthala, MS
Research Staff
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Anna Burroughs
Medical Student
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Arash Shaban-Nejad, PhD
Associate Professor
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Samir Shah, MBA, MD, FRCPC
MD, Professor, FAAP
Methodist Le Bonheur Childrens Hospital, United States
Disclosure information not submitted.
Title: Social Determinants of Health Impact Hospital Length of Stay for Children with Severe Sepsis
Introduction/Hypothesis: We evaluated SDOH domains of neighborhood and economic stability for children positive for severe sepsis who were admitted to a children’s hospital in the Memphis and Shelby County, Tennessee area and their association with hospital length of stay (LOS). We hypothesize that SDOH related to neighborhood environment and economic stability are associated with prolonged hospital LOS in children with severe sepsis in our underserved community.
Methods: This is a single-center retrospective observational study. All children with severe sepsis living in the Memphis and Shelby County, Tennessee area admitted to a freestanding children’s hospital over an 18-month period were included. Severe sepsis was identified using an existing clinical decision support algorithm. SDOH information and demographics were collected from patient records and publicly available census-tract level data. The primary outcome was hospital LOS. Economic stability and neighborhood environment variables were analyzed: socioeconomic status, social vulnerability index (SVI), lead exposure (urban blight surrogate), and environmental health hazard index (EHHI). Descriptive analyses were conducted. Mixed effects Cox regression models were used to determine association of each risk factor on hospital LOS for univariate analyses. A hazard ratio (HR) < 1 indicates the risk of discharge is low or longer hospital LOS (p < 0.05).
Results: 176 patients were included in the analysis. The mean hospital LOS was 8.50 days (IQR 4.00-18.00). The population was 56% male with a median age of 2.8 years at admission (IQR 1.50-6.08). There were 128 Black/African American patients (73%). The median poverty rate was 28.35 (IQR 12.90-37.95) with a median income of $44, 852 (IQR $33,903-61,411). Low SVI was significantly associated with shorter hospital LOS (HR 2.44, IQR 1.16-5.14) and % population below the poverty rate was significantly associated with increased hospital LOS (HR 0.99, IQR 0.98-1.00). No other statistically significant relationships were found between other SDoH variables and hospital LOS.
Conclusions: Children with severe sepsis admitted to our hospital have prolonged LOS related to SDOH at our center. The relationship between additional SDOH and patient outcomes will require further study to impact care of this population.