Effects of Center-level Resources on Septic Shock and Mortality Incidence in Children with Acute Leukemia
Mentor: Alix Seif
Septic shock is a major cause of morbidity and mortality in children with acute leukemias. Early detection and aggressive treatment are crucial to successful management, and delays in delivering care can be deadly. Children who face barriers to accessing prompt medical evaluation and treatment have an outsized risk of experiencing these life-threatening complications and of subsequent excess mortality. We are investigating how individual social determinants of health and hospital practices influence risks of septic shock and deaths from septic shock in children treated for leukemia. A key component of this research is to study hospital factors that may contribute to delays in detecting and treating septic shock. In prior studies, we found hospitals with higher proportions of patients with public insurance have markedly higher rates of induction mortality, much of which is attributable to septic shock. Early detection and management of septic shock require adequate hospital resources, which may be decreased in hospitals with overall lower reimbursements due to a high public payer mix. Implementing hospital-based initiatives to improve early detection and treatment could save lives of children undergoing cancer therapy. We have already collected data on 49 hospitals in the Pediatric Health Information System (PHIS) database on annual patient volumes (total and those with leukemia), hospital demographics, and payer mix. We recently developed a new collaboration with the Children’s Hospital Association to use their PROSPECT database to evaluate hospital staffing, volume, and acuity by unit and will also use these data to track a child across units such as the emergency department, oncology unit, and intensive care unit. This new data source needs to be documented and collated with data from PHIS and from the American Hospital Association (AHA), which is the goal of this proposal.