OasisLMS

INTRODUCTION: Sepsis and head injury are common diagnoses in pediatric critical care, with data showing disparities by race/ethnicity for both conditions. We investigated the role of individual hospital-level variation in contributing to these disparities. METHODS: We used the most recent (2016) Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) including 80% of pediatric discharges from 4,200 U.S. hospitals across 47 states. Using multilevel causal logistic regression, clustered by hospital, race/ethnicity was tested for association with hospital mortality adjusting sequentially for individual-level (age, sex, insurance type, presence of chronic complex condition), admission-level (admission day, quarter, admitted through ED, transferred in, elective admission) and hospital-level (hospital region, size, location, control, teaching status, percent of patients who are Black and percent of patients who are uninsured) characteristics. Hospital-specific odds for mortality and median odds ratio for hospital effects were calculated for sequential models. RESULTS: 10,973 children with severe sepsis and 31,582 children with head injury were included. Mortality was 14.9% for severe sepsis and 4.1% for head injury. Mortality was higher among Black children with severe sepsis and head injury (crude OR 1.41 [95% CI: 1.20-1.65] and 1.27 [95% CI: 1.09-1.49] respectively). Hospital-specific ORs varied from 0.18 to 3.20 for severe sepsis and 0.27 to 3.24 for head injury, suggesting mortality effects dependent upon being admitted to a given hospital. The median odds ratio for the unadjusted model was 1.66 (95% CI: 1.50-1.81) for severe sepsis and 1.63 (95% CI: 1.49-1.77) for head injury, suggesting an average 1.6-fold increased mortality odds when comparing a better- to a worse-performing hospital. On sequential addition of all available patient-, admission- and hospital-level characteristics, this decreased to 1.34 (95% CI: 1.20-1.48) for severe sepsis and 1.43 (95% CI: 1.26-1.59) for head injury. CONCLUSIONS: Disparities exist in mortality from sepsis and head injury. Our study showed substantial hospital-level variability in patient mortality with only modest attenuation by individual and hospital level adjustments.