(303) Change in Caregivers or Caregiver Employment After Pediatric Acute Respiratory Failure

Introduction: The impact of critical illness on family dynamics is poorly measured. We sought to characterize the frequency of and patient and clinical factors associated with a change in caregiver(s) or their employment. We hypothesized that patients with a new functional morbidity at discharge would be more likely to have a change in caregiver(s) or caregiver employment and that social determinants of health (SDoH) would be an important modifier of this relationship.

Methods: This is a secondary analysis of a prospective cohort study of critically ill children with acute respiratory failure who required > 3 days of invasive ventilation. We characterized patients with chronic complex conditions using the Pediatric Medical Complexity Algorithm and quantified severity of organ dysfunction with the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score. We surveyed caregivers at pre-admission baseline, 1-month, and 12-months post-discharge to identify the child’s primary caregivers and their employment status. We collected insurance status and Childhood Opportunity Index (COI) as SDoH measures. We used logistic regression to test for factors associated with change in caregiver(s) or caregiver employment.

Results: At 1-month post-discharge, 39 of 123 (31.7%) had a change; 14 (11.4%) had a change in primary caregiver(s) and 25 (20.3%) had a change in caregiver employment. At 12-months post-discharge, 49 of 115 (42.6%) had a change; 16 (13.9%) had a change in caregiver(s) and 33 (28.7%) had a change in caregiver employment. After controlling for age, complex chronic conditions, baseline caregiver employment, new morbidity at hospital discharge, and social and economic index, higher maximum PELOD-2 score (Odds Ratio (OR) 1.19 [95% Confidence Interval (CI): 1.01, 1.41]) and government insurance (OR 3.85 [95% CI: 1.33, 11.11) were risk factors for change in caregiver(s) or their employment at 1-month post-discharge.

Conclusions: Patients who survive critical illness are at risk of experiencing a change in caregiver(s) or caregiver employment post-discharge, particularly those with higher illness severity or government insurance. Further research is needed to inform development of support for children and families who experience critical illness.