Pediatric Sepsis Mortality Risk Marred by Racial Health Disparities

Pediatric patients who are Black are far more likely to die from sepsis than their White counterparts, even within a single hospital, a new analysis presented at the 2023 American Academy of Pediatrics National Conference & Exhibition showed.

The data is remarkable because it highlights a significant racial health disparity in pediatric sepsis mortality risk within a single healthcare organization, a detail which can help explain away differences in clinical quality had the analysis included different hospitals.

"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," Michael Stroud, the study’s lead author and a professor of Pediatric Critical Care at the University of Arkansas for Medical Sciences, said in a statement.

“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,” added Stroud, who is also a critical care doctor at Arkansas Children’s Hospital Little Rock.

Stroud and his research team conducted a retrospective analysis of all pediatric sepsis cases at Arkansas Children’s Hospital (ACH) between January 2018 and April 2022. That included 3,514 patients with sepsis, severe sepsis, or septic shock. For 1.65 percent of cases, sepsis resulted in mortality, the team reported.

But there were steep racial health disparities at play. Overall, Black kids were 2.5 times more likely to die from sepsis compared to their White counterparts.

While sepsis mortality was 1.27 percent for White children, it was 3.13 percent for Black children.

These findings come amid serious advances in sepsis treatment, Stroud pointed out. ACH, for example, uses automated algorithms to detect sepsis risk. These tools, called clinical decision support, send alerts to providers via the EHR and allow clinicians to identify and mediate sepsis early on, ideally improving outcomes.

It is incumbent on healthcare researchers to uncover why racial health disparities persist despite advancements in technology, Stroud said.

“Early recognition and resuscitation of pediatric sepsis has led to improved outcomes. Despite these advancements, Black children continue to have increased mortality rates,” he noted. “We must identify the factors contributing to this discrepancy and work to improve outcomes for all children, despite race, ethnicity, and socioeconomic status.”

Clinical decision support for sepsis still has a long way to go to improve health outcomes for patients. According to the researchers, the US still sees 40,000 pediatric hospitalizations and 5,000 deaths every year related to sepsis.

Infamously, some of these sepsis algorithms have had their shortcomings. While some hospitals have been able to use clinical decision support to cut sepsis rates, 2023 data in JAMA Network Open showed that the widely used, proprietary sepsis prediction model from Epic is less timely and misses more cases than other models.

To be clear, the ACH study abstract did not disclose which sepsis detection model the hospital used, but the findings are still salient.

While algorithms and clinical decision support technology has shown promise for addressing sepsis mortality, there are still some pitfalls, including steep racial health disparities that require further research and attention.