ABSTRACT
INTRODUCTION: Adverse Social Determinants of Health (SDoH) negatively impact child health outcomes. Outpatient SDoH screening is recommended by the American Academy of Pediatrics, but inpatient screening is not routine. This study sought to identify the prevalence of adverse SDoH in families of children admitted to a tertiary care pediatric intensive care unit (PICU) and to identify patient characteristics associated with positive screens. METHODS: An existing SDoH measure modified to include domains for which we were equipped to provide support was administered by a social worker to a primary caregiver of PICU patients from 2/18/20 - 6/4/20. Screens were positive if caregivers reported lack of access or worry about lack of access to services within the past year. Domains included housing, utilities (electricity, gas, water), childcare, mental health care and transportation. Patient demographics, diagnoses, lengths of stay, survival, and Pediatric Logistic Organ Dysfunction (PELOD) scores were collected from electronic medical records. Due to SARS-CoV-2, our study was paused from 3/9/20 - 4/21/20, allowing secondary analysis of SDoH before and after onset of the pandemic. All families received a resource guide in support of SDoH;families with positive screens were provided personalized support by social workers. RESULTS: Of the 84 families screened in the PICU, 26 (31%) screened positive for at least one adverse SDoH. Transportation (17%) and housing (13%) were the most commonly reported adverse SDoH. Thirteen (15%) families reported needs in multiple SDoH domains. There were no differences between patient characteristics, primary diagnosis, PELOD score, survival, or length of stay between families with positive or negative SDoH screening. In the post-SARSCoV- 2 epoch, children were older (9 vs. 4 years), had shorter PICU lengths of stay (3 vs. 7 days), and presented with less sepsis (19% vs. 67%) and more neurologic and respiratory diagnoses (30% vs. 3% and 20% vs. 13%). Adverse SDoH were similar between epochs. CONCLUSIONS: Almost a third of families with children admitted to the PICU had adverse SDoH. The optimal approach to routine screening and support of SDoH in families with critically ill children should be studied.