Huang Emma, Albrecht Lisa, O'Hearn Katie, Nicolas Naisha, Armstrong Jennifer, Weinberg Maya, Menon Kusum
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
Front Pediatr. 2024 Feb 1;12:1329648. doi: 10.3389/fped.2024.1329648. eCollection 2024.
The influence of social determinants of health (SDOH) on access to care and outcomes for critically ill children remains an understudied area with a paucity of high-quality data. Recent publications have highlighted the importance of incorporating SDOH considerations into research but the frequency with which this occurs in pediatric intensive care unit (PICU) research is unclear. Our objective was to determine the frequency and categories of SDOH variables reported and how these variables were defined in published PICU randomized controlled trials (RCTs).
We searched Medline, Embase, Lilacs, and Central from inception to Dec 2022. Inclusion criteria were randomized controlled trials of any intervention on children or their families in a PICU. Data related to study demographics and nine WHO SDOH categories were extracted, and descriptive statistics and qualitative data generated.
586 unique RCTs were included. Studies had a median sample size of 60 patients (IQR 40-106) with 73.0% of studies including ≤100 patients and 41.1% including ≤50 patients. A total of 181 (181/586, 30.9%) studies reported ≥1 SDOH variable of which 163 (163/586, 27.8%) reported them by randomization group. The most frequently reported categories were food insecurity (100/586, 17.1%) and social inclusion and non-discrimination (73/586, 12.5%). Twenty-five of 57 studies (43.9%) investigating feeding or nutrition and 11 of 82 (13.4%) assessing mechanical ventilation reported baseline nutritional assessments. Forty-one studies investigated interventions in children with asthma or bronchiolitis of which six reported on smoking in the home (6/41, 14.6%).
Reporting of relevant SDOH variables occurs infrequently in PICU RCTs. In addition, when available, categorizations and definitions of SDOH vary considerably between studies. Standardization of SDOH variable collection along with consistent minimal reporting requirements for PICU RCT publications is needed.
健康的社会决定因素（SDOH）对危重症儿童获得医疗服务及治疗结果的影响仍是一个研究不足的领域，高质量数据匮乏。近期的出版物强调了将SDOH考量纳入研究的重要性，但在儿科重症监护病房（PICU）研究中出现这种情况的频率尚不清楚。我们的目标是确定已发表的PICU随机对照试验（RCT）中报告的SDOH变量的频率和类别，以及这些变量是如何定义的。
我们检索了从创刊至2022年12月的Medline、Embase、Lilacs和Central数据库。纳入标准为对PICU中的儿童或其家庭进行任何干预的随机对照试验。提取与研究人口统计学和世界卫生组织的九个SDOH类别相关的数据，并生成描述性统计数据和定性数据。
纳入了586项独特的RCT。研究的样本量中位数为60例患者（四分位间距40 - 106），73.0%的研究纳入患者≤100例，41.1%的研究纳入患者≤50例。共有181项（181/586，30.9%）研究报告了≥1个SDOH变量，其中163项（163/586，27.8%）按随机分组报告了这些变量。报告最频繁的类别是粮食不安全（100/586，17.1%）以及社会包容和非歧视（73/586，12.5%）。在57项调查喂养或营养的研究中有25项（43.9%）以及在82项评估机械通气的研究中有11项（13.4%）报告了基线营养评估。41项研究调查了对哮喘或细支气管炎儿童的干预措施，其中6项报告了家中吸烟情况（6/41，14.6%）。
PICU RCT中对相关SDOH变量的报告并不常见。此外，即便有相关报告，不同研究之间SDOH的分类和定义差异也很大。需要对SDOH变量收集进行标准化，并对PICU RCT出版物制定一致的最低报告要求。
