119 - Impact of Race/Ethnicity, Primary Language, and Socioeconomic Status on Pediatric Sepsis Care in the Emergency Department

Poster Number: 119
Publication Number: 119.1684

Background: While robust evidence demonstrates the influence of race/ethnicity and socioeconomic disparities on sepsis mortality in adults, few pediatric studies exist. Identifying where disparities exist is crucial in providing equitable care and improving pediatric sepsis outcomes.

Objective: To measure the association of race/ethnicity, language, and socioeconomic status (SES) on: time to fluid and antibiotics; emergency department (ED) length of stay (LOS); and hospital LOS in pediatric sepsis resuscitation.

Design/Methods: Data from July 2020 to July 2023 were collected using a retrospective cohort design. Inclusion criteria were University of New Mexico (UNM) Pediatric ED visits of children 2 months-18 years with the ICD codes for: sepsis, severe sepsis, septic shock, bacteremia, bacterial meningitis, febrile neutropenia, and fever associated with underlying conditions. Patients who did not meet sepsis criteria as defined by the International Pediatric Sepsis Consensus Conference were excluded. UNM is the only tertiary-care children’s hospital in New Mexico, which is a majority-minority state and where more than a quarter of children live below poverty level.

Median household income was derived from zip codes using the U.S. Census data; this was used as a proxy for SES. Kruskall Wallis analyses measured the effect of self-reported race/ethnicity, primary language, and SES on sepsis interventions and LOS.

Results: There were 202 patients who met inclusion criteria. Over half were Hispanic/Latino (53.5%), spoke English (90.6%), and had SES below national median household income of $74,580 per U.S. Census (87.6%) (Table 1). Among patients with severe sepsis and septic shock, there was no difference in time to sepsis interventions by race/ethnicity, language, or SES (Table 2). All patients with sepsis not in the “severe sepsis/septic shock” group were administered fluids and antibiotics within 3 hours regardless of demographics.

Patients who spoke a language other than English had longer ED LOS (350 min, p = 0.024) compared to English speakers (Table 3). ED and hospital LOS were not significantly associated with other patient demographics.

Conclusion(s): Patients were treated similarly by providers, regardless of demographics. These findings may be attributed to the New Mexico unique population. Further research is warranted to investigate processes that lead to similar care and barriers to timely interventions for pediatric severe sepsis and septic shock.