P3.O294: Discrepancies in Risk of In-Hospital Deterioration by Race and Insurance Type

Background: Hospitalized children may deteriorate rapidly, leading to an escalation of care or even cardiopulmonary arrest. Prompt detection of clinical decline is essential to facilitate timely medical intervention and decrease morbidity and mortality. The Pediatric Early Warning System (PEWS) can identify individuals at heightened risk of deterioration using clinical indicators. We sought to identify demographic and social disparities in health that may contribute to inpatient deterioration.

Methods: We performed a single-center retrospective study of all admissions to the pediatric general floors from 2016-2022. The primary outcome was a clinical deterioration event, defined as an unplanned transfer to the intensive care unit (ICU) or death.

Results: We identified 29,769 hospitalizations, and 1809 deterioration events (incidence of 6.1%). Deterioration occurred at a median 109 hours after admission. Children who deteriorated were younger (2.2 v 5.9 years, p < 0.001), proportionally less likely to be white (41% v 49%, p< 0.001), and more likely to have public insurance (60% v 50%, p< 0.001) compared to those who did not. In a multivariable logistic regression analysis, age (OR 0.94 per year, p < 0.001), prematurity (OR 1.28, p< 0.001), Black race (OR 1.18 compared to White race, p=0.005), and insurance type (OR 1.32, p< 0.001) were all independently associated with an increased risk of a deterioration event. PEWS scores on admission differed significantly by race (0.63 for White v 0.70 for Black children, p< 0.001) and insurance type (0.72 for public v 0.61 for private, p< 0.001). No difference was seen in max PEWS score prior to deterioration by race (p=0.88) but were higher for those with public insurance (3.0 v 2.6, p< 0.001).

Conclusion: We found that young age, prematurity, non-white race, and public insurance are independently associated with deterioration in the hospital setting. Admission PEWS scores differed significantly by race and payor type, suggesting potential differences in the initial severity of illness. Further research is needed to elucidate further reasons for racial and insurance disparities in the risk of unplanned ICU transfer in hospitalized children.