Clinical correlations with unmet social needs in critically ill children with asthma

Background

Social drivers of health have been implicated as playing a major role in determining pediatric asthma outcomes. However, the impact of self-reported, family-level unmet social needs on asthma outcomes in critically ill pediatric patients is unknown.

Objective

Our aim was to determine whether the presence of unmet social needs at the time of intensive care unit (ICU) admission are associated with ICU-related and postadmission outcomes.

Methods

This was a 12-month (February 2022-January 2023) prospective cohort study at a single, urban pediatric health care system. Families of patients admitted to the pediatric ICU for asthma were screened for unmet social needs in multiple domains. Regression analyses were performed to correlate unmet needs with the following clinical outcomes: duration of bilevel positive airway pressure use; lengths of ICU and hospital stay; and rates of 6-month outpatient follow-up, ED visitation, and hospital readmission.

Results

Of 164 screened families, 57% reported at least 1 unmet social need. Unmet needs were significantly associated with longer hospitalizations (ie, a 3% increase per year of age (odds ratio =1.03 [95% CI = 1.00-1.07]) and a higher likelihood of returning for emergency care (adds ratio =2.6 [95% CI = 1.1-6.2]), even after accounting for race, insurance payer, and medical comorbidities. Additionally, patients provided with resources reported fewer needs when rescreened at outpatient follow-up (median = –1 need [P = .001]).

Conclusion

Families of critically ill pediatric patients with asthma reported a high rate of unmet social needs. Furthermore, those with needs were vulnerable to longer stays and repeat asthma exacerbations requiring emergency care. Identification of these families presents an opportunity to target a high-risk population with durable medical and social interventions.