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DEI Abstract Award Winner: Socioeconomic Disadvantage and Post-PICU Outcomes in Children with an Acquired Brain Injury
Description
Background and Purpose: Socioeconomic disadvantage (SED) is associated with increased pediatric intensive care unit (PICU) utilization and admission severity of illness. Few studies evaluate impact of SED on post-PICU outcomes. We aimed to examine associations between SED and functional disability after PICU hospitalization with acquired brain injury (ABI).

Methods: Retrospective cohort study of 455 children aged ≥3-18 years surviving PICU admission with ABI and completing follow-up 1-3 months post-discharge in a PICU follow-up clinic. SED was measured using Child Opportunity Index by zipcode (COI; higher scores=less disadvantage) and Area Deprivation Index by address (ADI; higher scores=more disadvantage) referenced to state. COI was categorized by standard quintiles. ADI was grouped into lowest three, middle four, and highest three deciles. New disability defined as worsening ≥1 point from baseline in Functional Status Scale (FSS) total score at follow-up. Logistic regression evaluated odds of new disability. Significance defined as p<.05.

Results: New disability at follow-up was present in 96 (21%) children with ABI. New disability increased with SED measured by very low versus very high COI [Odds Ratio (OR)= 3.38, 95% Confidence Interval (CI)= 1.51-7.57] and with high versus low ADI (OR= 1.98, 95% CI= 1.07-3.67). Multivariable logistic regression controlling for age, sex, severe traumatic brain injury diagnosis, critical care intervention, and length of stay found increased SED measured by very low versus very high COI significantly increased odds of new disability [adjusted OR= 3.75; 95% CI= 1.5-9.1]. A similar relationship was found comparing high to low ADI, but did not maintain statistical significance in multivariable models.

Conclusion: Our study found measures of SED were associated with increased post-PICU morbidity in children with ABI when controlling for demographic and clinical characteristics including severity of illness measures. Future research is needed to identify modifiable targets to improve disparities in post-PICU outcomes after ABI.

Event Type
Abstract
General Session
TimeWednesday, October 16th8:00am - 8:15am PDT
LocationHarbor Ballrooms D-I
Focus Areas
Pediatric