425 - Assessing Health Equity in Pediatric Sepsis Care

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 425
Publication Number: 425.219

Ali M. Armstrong, Primary Children's Hospital, Salt Lake City, UT, United States; Kelly Huynh, Primary Children's Hospital, Salt Lake City, UT, United States; Roni D. Lane, University of Utah School of Medicine, Salt Lake City, UT, United States; Jennifer K. Workman, University of Utah School of Medicine, Salt Lake City, UT, United States; Amber Chambers, Primary Children's Hospital, Salt Lake City, UT, United States

Presenting Author(s)

Amber Chambers, MD (she/her/hers)

Pediatric Hospitalist
Primary Children's Hospital
Salt Lake City, Utah, United States

Co-Author(s)

AA

Ali M. Armstrong, MD (she/her/hers)

Pediatric Resident-PGY3
Primary Children's Hospital
Salt Lake City, Utah, United States

Background: Emerging data suggest that socioeconomic, racial, and ethnic variables impact pediatric sepsis outcomes. Disparities in our local sepsis program are unknown, but likely exist.

Objective: To determine if timeliness of pediatric emergency department (ED) sepsis interventions are associated with social determinants of health, including the National Child Opportunity Index (COI), race/ethnicity, or language preference.

Design/Methods: This retrospective cohort study assessed the association between social determinants of health and timeliness of sepsis interventions among children presenting to the Primary Children’s Hospital (PCH) ED with sepsis from Jan 2018-May 2022. PCH is a free-standing, tertiary care children’s hospital with a long-standing pediatric sepsis quality improvement program. Predictors of interest included National COI, race/ethnicity, and language preference. COI is based on a wide variety of neighborhood level resources and is considered a proxy for socioeconomic status. COI categories range from Very Low-Very High level of opportunity. Outcomes of interest included time to IV placement, first fluid bolus, antibiotics, and vasopressors. Multivariable logistic regression was used to evaluate the association between determinants of health and timeliness of sepsis interventions.

Results: The cohort included 1017 patients. Many patients were White (67.4%) and English speaking (92.3%) (Table 1). The distribution of COI by race/ethnicity, language, and insurance status is shown in Figure 1. Overall, sepsis interventions were timely, with median time to first fluid bolus 19 minutes (IQR 13-28) and time to antibiotics 28 minutes (IQR 19-41). In the adjusted analysis, there were no significant differences in the time-to-intervention variables based on COI (Table 2). White patients had longer time to IV placement (Rate Ratio (RR) 1.26; 95% CI 1.01-1.58) and longer time to antibiotics (RR 1.18; 95% CI 1.02-1.36) than non-white patients. Time to IV placement for patients in the “other” language group was shorter than the English-speaking group (RR 0.55; 95% CI 0.31-0.98).

Conclusion(s): There were no significant differences in timeliness of interventions by COI. Significant differences in timeliness of interventions by race/ethnicity and language preference had unexpected directions of association. This suggests the need for further investigation with particular attention to the limitations of the analysis, including limited number of patients in some groups, lack of adjustment for severity of illness, and relatively low variation in overall timeliness of interventions.