(814) Childhood Opportunity Index and Pediatric Critical Care Utilization Following a Drowning Event

Sunday, February 23, 2025

9:45am – 10:45am Eastern Time

Location: Connections Central - RST 05

First Author(s)

Hannah R. Lively-Endicott, MD (she/her/hers)

Childrens Hospital Los Angeles
Los Angeles, California, USA

Co-Author(s)

MK

Margaret Klein, M.S.

Biostatistician II
Children's Hospital Los Angeles, United States
Vanessa R. Toomey, MD, MBA (she/her/hers)

Childrens Hopital Los Angeles
Los Angeles, USA
BM

Barry Markovitz, MD, MPH

Professor of Pediatrics
Intermountain Primary Children’s Hospital, United States
Jenny Kingsley, MD, MA, HEC-C

Assistant Professor of Pediatrics
Children's Hospital Los Angeles
Los Angeles, California, United States

Introduction: Drowning is the leading cause of death in children ages 1-4. To our knowledge, no previous studies have evaluated the relationship between the social determinants of health (SDOH) and drowning severity of illness or outcomes in the pediatric intensive care unit (PICU) population using a validated composite measure of SDOH. We studied the association between Childhood Opportunity Index (COI) and complexity of care on arrival to the PICU and hospital outcomes after drowning.

Methods: In this retrospective cohort study of patients aged 0-18, admitted for accidental drowning to Pediatric Health Information System database hospitals between 2012 and 2022, we hypothesized that lower COI was associated with greater complexity of care on day 0-1, longer hospital and PICU stay (LOS and pLOS, respectively), and a higher rate of in-hospital mortality (IHM). Complexity of care markers were defined as: cardiac arrest, EEG use, ventilatory support, invasive vascular access, extracorporeal membrane oxygenation (ECMO) cannulation, vasoactive medication use, and neuromuscular blockade. LOS, pLOS, and IHM were evaluated as outcomes. Comparisons were made between COI quintiles (Q1=very low, Q2=low, Q3=moderate, Q4=high, Q5=very high) using Chi-square and Kruskal-Wallis tests.

Results: Most patients in our study cohort (total n=4019) were male, preschool-aged children. Patients were split nearly equally among COI quintiles. Patients from lower COI quintiles had significantly longer median LOS (3 days in Q1 to Q3 vs. 2 days in Q4 to Q5; p < 0.001) and pLOS (2 days in Q1 to Q4 vs 1 day in Q5; p < 0.001), and higher rates (%) of mechanical ventilation (Q1 58.7, Q2 55.3, Q3 55.5, Q4 51.8, Q5 47; p < 0.001) and IHM (%) (Q1 24.7, Q2 22.4, Q3 23.8, Q4 22.6, Q5 17.7; p=0.013). There were no statistically significant differences between COI quintiles for any other complexity markers studied.

Conclusions: Patients with lower COI have longer hospitalizations, longer PICU stays, higher rates of mechanical ventilation on arrival, and higher in-hospital mortality rates after drowning. More research is needed to identify differences in care complexity throughout hospitalization, associations between COI and disability at discharge, and the influence that complexity on arrival has on care complexity throughout hospitalization.