Hospital-Specific Contribution to Mortality in Children With Severe Sepsis and Head Injury
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Sepsis, Quality and Patient Safety, Pediatrics, 2022
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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.
Meta Tag
Content Type Presentation
Knowledge Area Sepsis
Knowledge Area Quality and Patient Safety
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Sepsis
Tag Mortality
Tag Pediatrics
Tag Healthcare Delivery
Year 2022
hospital-level variation
pediatric critical care outcomes
severe sepsis
traumatic brain injury


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