597 - Increased Parental Concern as an Indicator of Acute Deterioration of Health in Children with Medical Complexities

Poster Number: 597
Publication Number: 597.403

Flory L. Nkoy, University of Utah, Sandy, UT, United States; Bryan Stone, University of Utah, Salt Lake City, UT, United States; Xiaoming Sheng, College of Nursing, Salt Lake City, UT, United States; Nancy A. Murphy, University of Utah Health Sciences Center, Salt Lake City, UT, United States

Background: Increased concern about child’s health is commonly associated with seeking Emergency Room (ER) and hospital care by parents of children with medical complexity (CMC), but critical factors escalating parental concern have not been explored.

Objective: To assess the role of parent socio-demographic and child clinical factors in increasing parental concern about CMC’s health. Better understanding of these factors can inform development of interventions that might reduce ER visits and hospitalizations for CMC.

Design/Methods: Secondary data analysis of CMC (1-21 years) and parents who used MyChildCMC, a home monitoring app for CMC. The study was conducted between Jun 2019 and Dec 2019. Parents, enrolled during hospitalization, provided socio-demographics, used the app daily for 3 months (post-discharge) to record their child’s daily vital signs (temperature, heart rate, oxygen saturation and respiratory rate), symptoms (pain, seizure status, fluid intake/feeding and mental status) and oxygen requirement (increased/decreased current level). Parents also recorded level of concern about the child’s health status on a 4-point scale (1=none, 2=mild, 3=moderate, 4=very concerned). Parental concern scores were dichotomized (3-4 vs. 1-2) and used as the dependent variable. Analysis used multilevel mixed effects logistic regression including parent as random effect, and sine/cosine applied to time to account for the effect of time of day on measurements. Results were reported as Odds Ratios (OR), 95% Confidence Intervals (CI), with their P-values.

Results: We analyzed 1223 measurements from 24 CMC. Child clinical factors associated with increased parental concern were increased temperature (OR: 1.35; 95%CI: 1.02-1.79, p=0.038), reduced heart rate (OR: 0.98; 95%CI: 0.96-1.00, p=0.027), increased pain (OR: 9.28; 95%CI: 4.59-18.78; p < 0.001), increased oxygen requirement (OR: 33.15; 95%CI: 11.00-99.92; p < 0.001), and reduced nutrition/fluid intake (OR: 119.70; 95%CI: 19.95-718.08; p < 0.001). No association was found between parental concern and any parent socio-demographic factors. Conclusion(s): Increased parental concern was associated with objective changes in child clinical parameters and is an indicator of acute deterioration in CMC’s health, with changes in pain, oxygen requirement and nutrition/fluid intake having the greatest impact. Monitoring parental concern, and early identification and management of these parameters might reduce the need for escalating care to ERs and hospital units.