Introduction: Bronchiolitis is one of the most common reasons for pediatric intensive care unit (PICU) admission in the U.S., yet it has significant disparities in treatment based on social determinants of health. The purpose of this study was to assess for associations between the Child Opportunity Index (COI) and PICU outcomes in children with bronchiolitis. Methods: Secondary analysis of a multicenter retrospective cohort study including data from 15 PICUs from 1/1/2019-12/31/2020. The dataset was queried for patients 0-2 years of age with bronchiolitis as the primary diagnosis for PICU admission. Patient addresses were mapped to COI 2.0 and assigned to a quintile (very low, low, moderate, high, very high). Demographics and clinical features were compared by COI quintile. Primary outcomes were severity of illness on presentation via PRISM III score and use of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV). Secondary outcomes were PICU length of stay (LOS) and mortality. Results: Of 3,671 total admissions, the very low COI group had the highest proportion of admissions (28.1%) and history of prematurity (33%). There was no difference in PRISM III scores across all groups. Paired comparisons of COI groups revealed significantly higher use of NIV in the very high COI group compared to the lowest 3 COI groups (p ≤ 0.008). Both the very high and very low groups had lower rates of intubation compared to low and moderate groups (p ≤ 0.04). Neither PICU LOS nor mortality differed significantly across all groups. Multivariate analysis showed PRISM III score (aOR 2.77, 95% CI 2.34-3.27) and prematurity (aOR 1.32, 95% CI 1.05-1.66) as independent risk factors for any positive pressure ventilation (PPV both IMV and NIV), but no difference for COI group. Conclusions: In this study, children admitted to the PICU with bronchiolitis are more often from very low COI neighborhoods. Patients from very high COI neighborhoods are more likely to receive NIV support and less likely to require intubation. Interestingly, patients from the very low COI group are also less likely to need intubation compared to the low and moderate COI groups. Higher PRISM III scores and prematurity were risk factors for PPV use, but COI group was not.
Stone et al. (Sun,) studied this question.