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WASHINGTON -- Black children treated at an Arkansas hospital had more than twice the risk of dying from sepsis than white children, even when clinical responses were similar, a retrospective study found.

According to preliminary findings, the sepsis mortality rate in Black children was 3.13% compared with 1.27% in white children (OR 2.51, 95% CI 1.43-4.40, P=0.001), reported Michele Moss, MD, of the University of Arkansas for Medical Sciences College of Medicine in Little Rock.

The study looked at more than 3,500 pediatric patients with a sepsis episode at Arkansas Children's Hospital from 2018 to 2022. Black patients represented 40% of all sepsis deaths in the study sample despite representing just over a fifth of the study population, while white patients accounted for 47%, and 13% were children of other races, according to a poster presentation at the annual meeting.

Even with improvements in the early recognition and resusciation of children with sepsis, approximately 40,000 children are hospitalized and 5,000 die each year from sepsis in the U.S. These preliminary findings are "one more piece of evidence" of disparities in sepsis outcomes, Moss said.

What surprised Moss and her colleagues was that the care that Black and white children received appeared similar. Of the patients who received antibiotics beyond the suggested time frame for their administration, 21.7% were Black and 18.5% were white, while of those who received IV fluid boluses, 8.7% were Black and 14.8% were white, both of which were non-significant differences.

"The two things that are getting measured in the big collaborative of sepsis recognition are time to first antibiotic, and time to first bolus fluid," Moss said. "And those were equal in our study, and yet the outcomes were different."

Co-author Macey Feimster, a fourth-year medical student at the University of Arkansas for Medical Sciences College of Medicine, noted that "it's definitely not enough to rule out any conscious or unconscious biases, but it does make you think, is there something more?"

"We don't know if it's a baseline difference in their health ... is it socioeconomic issues? ... or is it genetic type problems? We just don't know," she added. "So, I think [the study] is just opening the door to more investigation."

Moss said that future studies should look more closely at all of these factors.

This retrospective analysis included all patients at Arkansas Children's Hospital diagnosed with sepsis, severe sepsis, or septic shock from January 2018 to April 2022. The hospital leveraged a best practice advisory (BPA) within its electronic medical record to help flag cases of sepsis, which recommends the clinician activate protocol that begins with a bedside huddle followed by other specific clinical interventions.

The study included 3,514 children, 60% of whom were white. Most were girls, and mean age was 8 years.

The most significant limitation of the study is that it's "superficial," said Moss. "It doesn't dive into a lot of background information on the patient or the bacterial causes" of sepsis.

Moss also noted that she and her team were not able to determine whether patients presented in a timely manner or how sick they were before they came to the hospital.

"Were the white kids sick the day before they triggered sepsis, and the Black kids 2 days? We don't have that data," she said. "There's a whole lot more work that has to be done."

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