OBJECTIVES: Screening for social determinants of health in the inpatient setting is uncommon. However, social risk factors documented in billing and electronic medical record data are associated with increased pediatric care use. We sought to describe (1) the epidemiology of social risks and referral acceptance and (2) association between social risks identified through routine inpatient screening and care use. METHODS: Parents of children ages 0 to 18 admitted to a general pediatric floor at an academic children’s hospital completed a psychosocial screening survey from October 2017 to June 2019. The survey covered the following domains: finances, housing, food security, medications, and benefits. Patient characteristics and care use outcomes were abstracted from the electronic medical record and compared by using Pearson’s χ2 or the Wilcoxon rank test and logistic regression analyses. RESULTS: Of 374 screened families, 141 (38%) had a positive screen result, of whom 78 (55%) reported >1 need and 64 (45%) accepted a community resource. In bivariate analyses, patients with a positive screen result had higher 30-day readmission (10% vs 5%; P = .05), lower median household income ($62 321 vs $71 460; P < .01), lower parental education (P < .01), public insurance (57% vs 43%; P < .01), lived in a 1-parent household (30 vs 12%; P < .01), and had a complex chronic condition (35% vs 23%; P = .01) compared with those with a negative screen result. There was no difference in care reuse by screening status in adjusted analyses. CONCLUSIONS: Social risks are common in the pediatric inpatient setting. Children with medical complexity offer a good target for initial screening efforts.
OBJECTIVES: To identify variation in the proportion of blood cultures obtained for pediatric skin and soft tissue infections (SSTIs) among children’s hospitals. METHODS: We conducted a retrospective cohort study using the Pediatric Health Information System database, which we queried for emergency department (ED)–only and hospital encounters between 2012 and 2017 for children aged 2 months to 18 years with diagnosis codes for SSTI. The primary outcome was proportion of SSTI encounters during which blood cultures were obtained. Encounters with and without blood cultures were compared for length of stay, costs, and 30-day ED revisit and readmission rates, adjusted for patient factors and hospital clustering. We also identified encounters with bacteremia using billing codes for septicemia and bacteremia. RESULTS: We identified 239 954 ED-only and 49 291 hospital SSTI encounters among 38 hospitals. Median proportions of ED-only and hospital encounters with blood cultures were 3.2% (range: 1%– 11%) and 51.6% (range: 25%–81%), respectively. Adjusted ED-only encounters with versus without blood culture had higher costs ($1266 vs $460, P < .001), higher ED revisit rates (3.6% vs 2.9%, P < .001), and higher admission rates (2.0% vs 0.9%, P < .001). Hospital encounters with blood culture had longer length of stay (2.3 vs 2.0 days, P < .001), higher costs ($5254 vs $4425, P < .001), and higher readmission rates (0.8% vs 0.7%, P = .027). The overall proportion of encounters with bacteremia was 0.6% for ED-only encounters and 1.0% for hospital encounters. CONCLUSIONS: Despite multiple studies in which low clinical value was demonstrated and current Infectious Diseases Society of America guidelines arguing against the practice, blood cultures were obtained frequently for children hospitalized with SSTIs, with substantial variation across institutions. Few bacteremic encounters were identified.