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

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.Author summary: The social determinants of health (SDoH) are fundamental factors that contribute to overall health and health-related outcomes. Children in lower socioeconomic areas are at greater risk of critical illness or worse outcomes compared to those in more socioeconomically advantaged areas. Therefore, the inclusion of SDoH information into model development may lead to improved performance in clinical risk prediction models. In this work, we investigate whether the Child Opportunity Index (COI 3.0), a multi-dimensional child-specific indicator of neighborhood environment developed using the SDoH, 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. Our results show that despite differences in COI 3.0 characteristics and in-hospital mortality between the two PICUs, the addition of COI 3.0 variables did not improve the overall model performance. These findings suggest that the association of COI 3.0 variables with different outcomes, such as readmission, needs to be investigated further.