Related Experiment Video
Updated: May 9, 2026
A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
Trends in the epidemiology of pediatric severe sepsis*
Mary E Hartman1, Walter T Linde-Zwirble, Derek C Angus
11Department of Pediatrics, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, MO. 2ZD Associates, LLC, Perkasie, PA. 3Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 4Clinical Research, Investigation, and Systems Modeling in Acute illness (CRISMA) Center, Pittsburgh, PA.
Insights
Pediatric severe sepsis hospitalizations increased significantly between 1995 and 2005, driven by a rise in newborn cases. Despite increased prevalence, the overall case-fatality rate for severe sepsis in children declined.
Area of Science:
- Pediatric critical care
- Infectious disease epidemiology
- Healthcare quality improvement
Background:
- Severe sepsis remains a significant U.S. healthcare challenge, with over 720,000 annual hospitalizations.
- Despite established guidelines, large-scale epidemiologic data on pediatric severe sepsis are limited.
- Understanding trends in pediatric severe sepsis is crucial for effective public health strategies.
Purpose of the Study:
- To examine changes in case mix, outcomes, and resource utilization for pediatric severe sepsis.
- To analyze trends in pediatric severe sepsis prevalence and associated mortality over time.
- To identify demographic and clinical factors influencing severe sepsis in children.
Main Methods:
- Retrospective analysis of a cohort dataset from seven U.S. states (1995, 2000, 2005).
- Inclusion of all acute-care hospitalizations for children aged 0-19 years.
- Identification of severe sepsis cases using International Classification of Diseases, 9th Revision, Clinical Modification codes for infection and organ failure.
Main Results:
- Pediatric severe sepsis hospitalizations increased by 81% from 1995 to 2005, with a 45% rise since 2000.
- Prevalence increased from 0.56 to 0.89 cases per 1,000 pediatric population; newborn sepsis prevalence more than doubled.
- The overall case-fatality rate decreased from 10.3% to 8.9%, though Staphylococcus aureus-associated fatality rose.
Conclusions:
- The prevalence of severe sepsis in U.S. children rose steadily between 1995 and 2005.
- A significant increase in severe sepsis prevalence among newborns was the primary driver of this trend.
- While overall mortality decreased, specific pathogen-related fatalities shifted, highlighting evolving challenges in pediatric sepsis management.
Objectives:
In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S. healthcare problem, accounting for over 720,000 annual hospitalizations. Large-scale epidemiologic studies of severe sepsis continue to be limited, particularly in children. We present data from 1995, 2000, and 2005 in seven U.S. states, examining how case mix, outcome, and resource use for pediatric severe sepsis have changed over time.
Design:
We constructed a database including all acute-care hospitalizations for children in the seven states. For each case, we extracted data on demographic characteristics; the principal diagnosis, up to six secondary diagnoses, and six procedures as classified by the International Classification of Diseases, 9th Revision, Clinical Modification codes; and in-hospital fatality. We identified patients with severe sepsis using International Classification of Diseases, 9th Revision, Clinical Modification codes for both infection and acute organ failure.
Setting:
Retrospective observational cohort dataset from seven U.S. states from 1995, 2000, and 2005.
Subjects:
Children in the U.S. 0-19 years old.
Interventions:
None.
Measurements And Main Results:
In 2005, 17,542 children were hospitalized with severe sepsis in the seven states; there was an 81% increase in pediatric severe sepsis cases since 1995 and a 45% increase since 2000. This corresponded to an increase in prevalence from 0.56 to 0.89 cases per 1,000 pediatric population. Between 1995 and 2005, the prevalence of severe sepsis in newborns more than doubled, from 4.5 to 9.7 cases per 1,000 births. The most common infecting organisms in all 3 years were Staphylococcus species. From 1995 to 2005, the case-fatality rate decreased from 10.3% to 8.9%. Case fatality associated with Staphylococcus aureus increased, whereas fatality associated with Streptococcus pneumoniae decreased by 75%. Nationally, there were 75,255 pediatric hospitalizations in 2005 involving severe sepsis, with an associated cost of $4.8 billion.
Conclusions:
Between 1995 and 2005, the prevalence of severe sepsis in U.S. children steadily rose, due to a significant increase in the prevalence of severe sepsis in newborns.
Related Concept Videos
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:29Pneumonia I: Introduction