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Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database
Amanda Ruth1, Courtney E McCracken, James D Fortenberry
11Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA. 2Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA. 4Children's Hospital Association, Kansas City, MO.
Insights
Pediatric severe sepsis increased in prevalence but decreased in mortality from 2004-2012. Younger age, cardiovascular conditions, and organ dysfunction increased mortality risk in pediatric severe sepsis patients.
Area of Science:
- Pediatric critical care medicine
- Epidemiology
- Health services research
Background:
- Pediatric severe sepsis is a significant cause of mortality and morbidity in children.
- Understanding trends and risk factors is crucial for improving outcomes and resource allocation.
Purpose of the Study:
- To describe the characteristics, outcomes, and resource utilization of pediatric severe sepsis patients in U.S. children's hospitals.
- To identify patient subgroups at higher risk of mortality.
- To analyze trends in prevalence and mortality over time.
Main Methods:
- Retrospective review of a prospectively collected multi-institutional database (Pediatric Health Information System).
- Analysis of data from 43 U.S. children's hospitals between 2004 and 2012.
- Identification of pediatric severe sepsis using modified Angus criteria and ICD-9 codes.
Main Results:
- Prevalence of pediatric severe sepsis increased from 6.2% to 7.7% (2004-2012), while mortality decreased from 18.9% to 12.0%.
- Younger age (<1 year), cardiovascular conditions, and multiple organ dysfunction were associated with increased mortality.
- Significant healthcare resource burden observed, with a median total hospitalization cost of $77,446.
Conclusions:
- Despite increased prevalence, pediatric severe sepsis mortality has decreased, suggesting improved care.
- Age, cardiovascular comorbidity, and organ dysfunction remain key prognostic factors.
- Pediatric severe sepsis continues to represent a substantial healthcare cost and mortality burden, with center prevalence and volume linked to better outcomes.
Objective:
To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization.
Design:
Retrospective review of a prospectively collected multi-institutional children's hospital database.
Setting:
PICUs in 43 U.S. children's hospitals.
Patients:
PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock.
Interventions:
None.
Measurements And Main Results:
Data from the Pediatric Health Information System database collected by the Children's Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8-36 d) and PICU length of stay of 7 days (interquartile range, 2-17 d), with median cost/day of $4,516 and median total hospitalization cost of $77,446. There was a significant increase in the severe sepsis prevalence rate from 6.2% to 7.7% from 2004 to 2012 (p < 0.001) and a significant decrease in mortality from 18.9% to 12.0% (p < 0.001). Center mortality was negatively correlated with prevalence (rs = -0.48) and volume (rs = -0.39) and positively correlated with cost (rs = 0.36).
Conclusions:
In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes.
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