No Association of Child Opportunity Index in Critical Pediatric Respiratory Disease

Introduction: Social determinants of health (SDoH) have been shown to have a significant effect on respiratory health early in a child’s life. Despite advancements in management, Pediatric Intensive Care Unit (PICU) admissions are increasing for respiratory diseases. This incongruency warrants further investigation. We hypothesized there will be a significant difference in length of stay between children from low SDoH compared to children from high SDoH.


Methods: A single center retrospective chart review was conducted from 2018-2023 of patients aged 0-5 years admitted to the University of Maryland Medical Center (UMMC) PICU for acute respiratory condition (e.g. bronchiolitis, status asthmaticus). Patients included were those being admitted to the PICU on HFNC from an emergency department (ED). Patients were grouped based on the Child Opportunity Index (COI), which utilizes 44 variables to determine the quality of resources and health of neighborhoods as a surrogate for SDoH. Referring hospitals were also classified by pediatric capabilities and considered as an independent variable. Primary outcome was length of stay (LOS) with a secondary outcome of de-escalation of respiratory support in first 24 hours. Results are reported in median (IQR) with tests of significance using Kruskal-Wallis rank sum test.


Results: Our preliminary dataset includes 416 patients. LOS (days) was found to be non-significant between COI groups (Very Low: 3 (2-3), Low: 3 (2-4), Moderate: 3 (2-4), High: 3 (2-4), Very High: 3 (2-4), p = 0.267). Preliminary analysis showed no significant difference in LOS between gender, race, and type of insurance. Change in respiratory support was found to be nonsignificant for COI groups and referring hospital pediatric capabilities. The total change of respiratory support was 66.6% decreased and 33.4% remained unchanged or increased within 24 hours of PICU admission.


Conclusions: Our preliminary findings suggest that there is no association between SDoH and referring hospital capability and length of stay for pediatric patients admitted with critical respiratory disease requiring HFNC. As our work identified that there is a substantial percentage of children who wean respiratory support in the first 24 hours, we will continue investigating risk factors that may inform triage and treatment.