Introduction: Race is associated with pediatric ICU (PICU) utilization and analgesic practices in acutely ill children. We aimed to evaluate if associations between race and analgo-sedative practices of ventilated PICU patients differed before and after 2020, a year that included the onset of COVID and national social and racial reckoning. Methods: With IRB approval, we queried the Pediatric Health Information System (PHIS) database for PICU patients who required mechanical ventilation (MV) between 2016 and 2024. Demographics, length of stay, diagnoses, and pharmacy billing data were extracted. Drug exposure was calculated as days on the medications of interest (fentanyl, morphine, propofol, dexmedetomidine, midazolam and ketamine) divided by days on MV. Variables were compared between “before” (2016-2019) and “after” (2021-2024) subjects using standard statistical tests and multiple linear regression models that included illness severity, primary diagnoses, and post-operative status, with p< 0.05 defining significance. Results: Among 146,095 patients, 57% were male, 59% publicly insured, 44% non-Hispanic White, and 22% from low childhood opportunity indices. Median duration of MV was 5 days (IQR: 2-11) and 17% had primary respiratory illness. Race, primary diagnosis and age (17 2-99 vs. 20 2-116 mo, p< 0.001) differed significantly between before and after. In univariate analysis, non-Hispanic Black patients received fewer days of sedation post-2020 compared to pre-2020, while Hispanic, non-Hispanic White and Unknown races received more days of sedation (all p< 0.001). In multivariate analysis, compared to non-Hispanic White subjects, subjects categorized in PHIS as Hispanic received more days of fentanyl, morphine, propofol and dexmedetomidine; and subjects categorized as non-Hispanic Black received fewer days of morphine, propofol, and dexmedetomidine (all p< 0.001), even after adjusting for epoch. Conclusions: In this administrative dataset, race was associated with differences in analgo-sedative practices in PICU patients on MV throughout the study period. Clinical factors may explain these observations, but racial bias cannot be excluded. Further studies are warranted to ensure that all PICU patients receive optimal analgo-sedative drugs during MV.
Bryant et al. (Sun,) studied this question.