Anireddy Reddy
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Katie Hayes, BS
Lead Clinical Data Management Specialist in the Pediatric Sepsis Program
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Hongyan Liu, PhD
Data Scientist
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Heather Griffis, PhD
Director of Data Science and Biostatistics
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Fran Balamuth, MD, PhD, MSCE, MD, PhD, MSCE
Associate Director of Research in the Emergency Department
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Julie Fitzgerald, MD, PhD, FCCM
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Scott Weiss, MD, FCCM
Associate Professor of Anesthesiology, Critical Care, and Pediatrics
The Children's Hospital of Philadelphia
Glen Mills, Pennsylvania, United States
Disclosure information not submitted.
Title: Racial, Ethnic, and Socioeconomic Disparities in Pediatric Sepsis Identified Using Electronic Data
Introduction: Racial, ethnic, and socioeconomic (SES) disparities are reported in sepsis, with increased mortality for minority and low SES groups. However, prior studies relied on billing codes that are imprecise in identifying sepsis. Our group recently validated a surveillance definition to detect children with sepsis using electronic clinical data; we hypothesized that racial/ethnic and SES disparities in outcomes would be evident in this group.
Methods: Retrospective study from a large tertiary academic center, including sepsis episodes from January 20, 2011 to May 20, 2021 identified by an algorithm indicative of bacterial infection with concurrent organ dysfunction. Race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, and other. SES was categorized using insurance status (private, public, self-pay) and quintiles of social disorganization. Logistic regression was used to assess the association of race/ethnicity and SES with in-hospital mortality, hospital admission, ICU admission, and readmission at 1 year.
Results: Among 7,288 total sepsis episodes representing 4,532 unique patients, the in-hospital mortality rate was 9.7%. Compared to non-Hispanic Whites, the odds of mortality were lower for non-Hispanic Blacks (0.67 [0.5-0.85]) and not significantly different for Hispanics (0.75 [0.54-1.02]) and other races (1.2 [0.91-1.56]). There was no difference in odds of mortality based on insurance. Patients with higher social disorganization had lower odds of mortality (Quintile 3 0.68 [0.49-0.92]; Quintile 4 0.74, [0.55-1.01]; Quintile 5 0.7 [0.51-0.95]). There was no association between our predictors and ICU admission. Non-Hispanic Blacks and those in Quintile 5 were twice as likely to be admitted to the hospital (Black 2.04 [1.41-3.02]; Quintile 5 2.18 [1.34-3.65]). Hispanic patients and publicly insured patients were more likely to be readmitted (Hispanic 1.28 [1.06-1.5]; Public 1.19 [1.05-1.35]) whereas as patients classified as Other or Self Pay were less likely to be readmitted (Other 0.79 [0.66-0.96]; Self Pay 0.43 [0.19-0.9]).
Conclusion: Previously observed racial/ethnic and SES disparities were not confirmed in children when sepsis was identified using electronic clinical data. Differences in admission/readmission rates require further investigation.