Association of the child opportunity index with in-hospital mortality and persistence of organ dysfunction at one week after onset of Phoenix Sepsis among children admitted to the pediatric intensive care unit with suspected infection.

PLOS digital health Pub Date : 2025-04-14 eCollection Date: 2025-04-01 DOI:10.1371/journal.pdig.0000763
Ronald Moore, Daniela Chanci, Stephanie R Brown, Michael J Ripple, Natalie R Bishop, Jocelyn Grunwell, Rishikesan Kamaleswaran
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Abstract

The social determinants of health (SDoH) are fundamental factors that contribute to overall health and health-related outcomes. Children living in lower socioeconomic areas have a higher risk of critical illness and worse outcomes compared to children living in more socioeconomically advantaged areas. In this work, we determine whether the Child Opportunity Index (COI 3.0), a multi-dimensional child-specific indicator of neighborhood environment, is associated with in-hospital mortality or persistence of a Phoenix Sepsis Score  ≥  2 at one week following Phoenix Sepsis onset in children admitted to pediatric intensive care units (PICUs) with suspected infection. We performed a retrospective cohort analysis of 63,824 patients with suspected or confirmed infection admission diagnosis in two PICUs in Atlanta, Georgia with a Georgia residential address that could be geocoded and linked to a census tract. The primary outcome was the composite of in-hospital mortality or persistence of a Phoenix Sepsis Score  ≥  2 at one week following Phoenix Sepsis onset. Model performance measures of interest were the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Models developed with electronic medical record (EMR) data using Egleston (EG) or Scottish Rite (SR) as the training site achieved AUROCs of 0.81-0.84 (95% CI range: 0.8-0.85) and 0.82-0.82 (95% CI range: 0.81-0.83) and AUPRCs of 0.59-0.68 (95% CI range: 0.58-0.69) and 0.62-0.64 (95% CI range: 0.61-0.65) respectively. Despite significant differences in COI 3.0 characteristics and overall in-hospital mortality of children with Phoenix suspected infection between the EG and SR PICUs, the addition of COI 3.0 did not improve the overall model performance metrics. While children admitted to both PICUs were more often from COI 3.0 neighborhoods in the lowest two quintiles, these neighborhood features had less of an impact on the model's predictive performance compared to patient physiologic and biologic features available in the EMR.

儿童机会指数与住院死亡率和持续器官功能障碍在凤凰脓毒症发作后一周在儿科重症监护病房怀疑感染的儿童的关联
健康的社会决定因素(SDoH)是促进整体健康和与健康有关的结果的基本因素。与生活在社会经济条件较好的地区的儿童相比,生活在社会经济条件较差地区的儿童患重病的风险更高,结果也更差。在这项工作中,我们确定儿童机会指数(COI 3.0),一个多维儿童特异性的邻里环境指标,是否与住院死亡率或凤凰脓毒症评分≥2的持续时间有关,凤凰脓毒症在怀疑感染的儿童入住儿科重症监护病房(picu)后一周发生。我们对佐治亚州亚特兰大市两个picu中63824例疑似或确诊感染的患者进行了回顾性队列分析,这些患者的居住地址可以进行地理编码并与人口普查区相关联。主要结局是住院死亡率或凤凰脓毒症评分≥2在凤凰脓毒症发病后一周的综合。感兴趣的模型性能测量是接收者工作特征曲线下的面积(AUROC)和精确召回率曲线下的面积(AUPRC)。使用Egleston (EG)或Scottish Rite (SR)作为训练场地的电子病历(EMR)数据开发的模型,auroc分别为0.81-0.84 (95% CI范围:0.8-0.85)和0.82-0.82 (95% CI范围:0.81-0.83),auprc分别为0.59-0.68 (95% CI范围:0.58-0.69)和0.62-0.64 (95% CI范围:0.61-0.65)。尽管COI 3.0特征和Phoenix疑似感染儿童的总体住院死亡率在EG和SR picu之间存在显著差异,但COI 3.0的加入并未改善整体模型性能指标。虽然入住picu的儿童更多地来自最低两个五分位数的COI 3.0社区,但与EMR中可用的患者生理和生物特征相比,这些社区特征对模型预测性能的影响较小。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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