Research finds Black children over twice as likely to die of sepsis at one hospital

AAP media contacts: Lisa Black, 630-626-6084, lblack@aap.org 

Tom McPheron, 630-626-6315, tmcpheron@aap.org  

                               Adam Alexander, 630-626-6765, aalexander@aap.org 

Washington, D.C.— A retrospective analysis of pediatric sepsis deaths at a large hospital in Arkansas found that Black children in the hospital were 2.5 times more likely to die of sepsis than white patients, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.  

Researchers who wrote the abstract, “Racial Disparity in Pediatric Sepsis Mortality,” conducted a retrospective analysis of all patients at Arkansas Children’s Hospital (ACH) with sepsis, severe sepsis, or septic shock between January 2018 and April 2022. Researchers found 3,514 patients had sepsis during the study period with an overall mortality rate of 1.65%. Mortality was 3.13% in Black children versus 1.27% in white children, revealing that black children were far more likely to die of sepsis. 

“Early recognition and resuscitation of pediatric sepsis has led to improved outcomes. Despite these advancements, Black children continue to have increased mortality rates,” said lead study author Michael Stroud, MD, FAAP, professor, Pediatric Critical Care University of Arkansas for Medical Sciences, Arkansas Children’s Hospital Little Rock. “We must identify the factors contributing to this discrepancy and work to improve outcomes for all children, despite race, ethnicity, and socioeconomic status.” 

Many hospitals and health centers have made advancements in how they respond to sepsis, which is a deadly emergency health risk. Today, many hospitals, like ACH, use automated, real-time, algorithm-based detection of sepsis, severe sepsis, and septic shock incorporated into the electronic medical record. This method leads to earlier recognition, resuscitation, and improved outcomes.  

However, despite improvements in early recognition and resuscitation, sepsis remains a major pediatric health issue with an estimated 40,000 hospitalizations and 5,000 deaths every year in the US.  

"Our research shows that mortality in black children remains higher when compared with white children, despite advances like automated recognition tools and timely administration of therapeutic interventions," Dr. Stroud said. “Further investigations are needed to identify if conscious and unconscious biases, potential socio-economic factors, and genetic predispositions are leading to racial disparities in outcomes of children with pediatric sepsis, severe sepsis, and septic shock.” 

This work was internally funded by the Arkansas Children’s Hospital. 

Dr. Stroud is scheduled to present his research, which is below, from 11:15 to 12:15 p.m. Saturday, Oct. 21, 2023, during session H2020. To request an interview with the authors, contact Michael Stroud, MD, at stroudmichaelh@uams.edu. 

 Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

ABSTRACT 

Submission Type: Section on Critical Care  

Abstract Title: Racial Disparity in Pediatric Sepsis Mortality  

Michael Stroud  

Little Rock, AR, United States  

Despite improvements in early recognition and resuscitation, sepsis remains a major pediatric health issue with an estimated 40,000 hospitalizations and 5,000 deaths every year in the US. Many centers now use automated, real-time, algorithm-based detection of sepsis, severe sepsis, and septic shock incorporated into the electronic medical record (EMR). This method leads to earlier recognition, resuscitation, and improved outcomes. Recent data shows a continued discrepancy in sepsis outcomes based on race, despite improvements in outcomes among children overall. We hypothesized that mortality rates remain higher in black children with sepsis, severe sepsis, and septic shock compared to white children, despite incorporation of automated screening tools into the EMR.  

A retrospective analysis of all patients at Arkansas Children’s Hospital (ACH) with sepsis, severe sepsis, or septic shock between January 2018 and April 2022 was conducted. ACH uses a best practice advisory (BPA) in the EMR for early detection in all hospital areas including the emergency department, all medical-surgical wards, all Intensive Care Units (ICU), and interfacility transport. EMR activation leads to a bedside huddle, followed by institution of clinical interventions. A sepsis episode (SE) was defined as BPA activation or a diagnosis of sepsis, severe sepsis, or septic shock in the EMR. Mortality rates, as well as demographic information and clinical outcome measures for children who died were compared between Black(B) and White(W) children. Student's t-test was used for categorical variables, chi-square for proportions, and odds ratio for overall mortality comparison.  

3,514 patients had a SE during the study period; 2126(W) and 736(B). Overall mortality was 1.65% (40%(B); 47%(W)). Mortality was 3.13% (23/736) in Black children versus 1.27% in White children; OR 2.51 (1.43,4.40), p=0.001. Basic demographics including gender (Female-56.52%(B), 55.56%(W); p=0.95) and age in years (8.00+/-2.78(B), 7.87+/-2.66; p=0.97) were similar. Clinical interventions including total IV antibiotic days (23.83+/-8.36(B), 21.56+/-9.59(W); p=0.38), vasoactive infusion days (2.17+/-1.44(B), 2.63+/-0.90; p=0.18), and percent requiring Extracorporeal Membrane Oxygenation (26.07%(B), 18.52%(W), p=0.52) were similar. Black children who died had a longer length of hospitalization (16.70+/-6.47(B), 12.70+/-5.85(W) days; p=0.03) and longer ICU stay (7.57+/-2.57(B), 5,70+/-2.27(W) days; p=0.01). Percent over threshold for antibiotic administration (21.74%(B), 18.52%(W); p= 0.78; 1h-septic shock, 3h-sespis) and IV fluid bolus administration (8.70%(B), 14.81%(W); p=0.51; 20 minutes-septic shock, 1h-sepsis) were similar.  

This single center, retrospective study shows that hospitalized Black children have a 2.5 times greater risk of death from sepsis compared to White children. Interestingly, this preliminary data suggests similar rates of timely resuscitation including antibiotic administration and IV fluid boluses. Further investigations are needed to identify biases (conscious and unconscious), potential socio-economic factors, and genetic predispositions leading to racial disparities in outcomes of children with pediatric sepsis, severe sepsis, and septic shock.