Introduction: Children with adverse social determinants of health (SDH) face a higher risk of admission to pediatric intensive care units (PICUs) and worse outcomes. SDH screening can identify health-related social needs (HRSN). Current SDH screening practices in North American PICUs are not well defined. We describe PICU SDH screening practices, hypothesizing that certain patient and hospital factors are associated with completed screening. Methods: Multicenter, prospective, point prevalence study of patients ≤21 years old admitted to one of 44 PICUs on one of two study days in 2022-2023. Data collected included: SDH screening practices, patient demographics (race/ethnicity, insurance type, childhood opportunity index (COI)), clinical data (complex chronic conditions (CCC), ICU therapies), and hospital factors (ICU type, academic status). Mixed-effects logistic regression models were used to identify factors associated with odds of completed SDH screen. Results: SDH screening was completed in 1064/1360 (78%) patients at 38 (86%) PICUs that routinely screened for SDH. Tools screened for economic stability (89%), healthcare access (82%), neighborhood (50%), social context (53%), and education (39%). Half (n=532) were screened on PICU day 1; 82% screened positive for economic instability, and 8.4% for poor healthcare access. Odds of completed screening were lower among those with private insurance (OR 0.6, 95%CI: 0.4-0.9) and military insurance (OR 0.1, 95%CI: 0.03-0.5) versus public insurance. Vasoactive therapy (OR 3.5, 95% CI: 2.1-5.9) and those with ≥3 CCC (OR 2.6, 95% CI: 1.4-5.2) versus none had increased odds of completed SDH screening. Race/ethnicity, COI, and hospital factors were not associated with completed SDH screening. Half (n=19) of the PICUs reported having action plans for positive screens (e.g., referral to hospital or community services). Conclusions: While most PICUs engaged in routine SDH screening, there is heterogeneity in the domains screened for, and only half had action plans for positive screens. Public insurance, CCC, and higher clinical acuity had higher odds of completed SDH screening. Further research is needed to inform the development of standardized SDH screening practices in the PICU and to address potentially unmet HRSN among critically ill children and their families.
Kalata et al. (Sun,) studied this question.