36-Community Level Income and Hospital Resource Utilization in Pediatric Severe Sepsis
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Pediatrics, Sepsis, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Bryan Combs

Introduction/Hypothesis: Severe sepsis is a leading cause of pediatric mortality and morbidity; in the US, it accounts for 7.7% of PICU admissions. Compared to other acute illnesses, disparities in health outcomes of low-income children with severe sepsis are not well known.

Methods: This was a retrospective cohort study using the de-identified Pediatric Health Information System (PHIS) database, which contains clinical and resource utilization data from 52 free-standing US children's hospitals. PHIS was queried for children <19 years old with severe sepsis, as defined by ICD-10 codes, from 1/1/16–9/30/19. Demographics, including estimated household income based on ZIP code were collected. Subjects were divided into 4 groups based on the federal poverty threshold (FPT), which in 2017 was $24,858 for a family of 4: <100%FPT, 100-150%FPT, 150-200%FPT, and >200%FPT. Illness severity and hospital outcomes including need for mechanical ventilation (MV), length of stay (LOS), estimated hospital costs, and mortality were compared between the groups. Statistical methods included chi square and Kruskal-Wallis.

Results: The median age of this cohort of 106,209 children was 6 years [IQR 1-13]. Most (57.2%) were white, most (58.2%) had public insurance, and 6.6% were living in poverty (<100%FPT). There were significant differences in patient demographics and illness severity based on income group (all p<0.001). Illness severity was classified as 'extreme' in 58.7% of children <100%FPT vs. 56.4% in children >200%FPT. MV was utilized in 47.6% of children <100%FPT vs. 42.4% of children >200%FPT, with significant differences found between the 4 income groups (p<0.001). There were significant differences between hospital LOS and estimated hospital costs between income groups (all p<0.001). Median LOS was 8 days [IQR 4-20] with estimated hospital costs $31,884 [IQR 12,513-88,895] for children <100%FPT, vs 7 days [IQR 3-17] and costs $28,906 [12,258-81,657] for children >200%FPT. Overall 4.0% (n=4,241) of children died, with no differences in mortality between income groups (p=0.096).

Conclusions: In this large multicenter cohort study of children with severe sepsis, differences in illness severity and hospital outcomes were found based on estimated median household income.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Sepsis
Knowledge Level Advanced
Membership Level Select
Tag Multiple Organ Dysfunction
Tag Scoring Systems
Tag Monitoring
Year 2021
Pediatric critical care fellow
Brian Combs
community-level income
hospital resource utilization
pediatric severe sepsis


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