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Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children

James T Gaensbauer1,2,3, Meghan Birkholz3, Michael A Smit4

  • 1From the Pediatrics and Infectious Diseases, Denver Health Medical Center, Denver, Colorado.

The Pediatric Infectious Disease Journal
|March 31, 2018
PubMed

Insights

Toxic shock syndrome (TSS) accounts for over 11% of pediatric septic shock cases. Recognizing TSS is crucial as it presents differently and has a better prognosis than other forms of pediatric septic shock.

Area of Science:

  • Pediatric Infectious Diseases
  • Critical Care Medicine
  • Epidemiology

Background:

  • Toxic shock syndrome (TSS) is a critical condition that can present as pediatric septic shock.
  • Clinical features, treatment, and prognosis of TSS differ from non-TSS septic shock, necessitating specific recognition.

Purpose of the Study:

  • To define the clinical and demographic characteristics of pediatric TSS in the United States.
  • To compare TSS cases with non-TSS septic shock to understand differences in presentation, severity, and outcomes.

Main Methods:

  • Analysis of pediatric septic shock cases from the Pediatric Health Information Systems database (2009-2013).
  • Utilized a validated ICD-9 coding strategy to identify and classify staphylococcal and streptococcal TSS.
  • Compared TSS cases with non-TSS septic shock in patients aged 1-18 years.

Main Results:

  • 11.1% of pediatric septic shock cases were identified as TSS (909 cases), with an additional 6.8% as possible TSS.
  • Staphylococcal TSS was more common (83% of TSS), occurring more in females and older children.
  • TSS cases had lower fatality rates, disease severity, and hospital stays compared to non-TSS septic shock, and were more often present at admission.

Conclusions:

  • Toxic shock syndrome significantly contributes to the burden of pediatric septic shock in the US.
  • Findings highlight the need to incorporate TSS diagnostic and therapeutic strategies into pediatric sepsis protocols.
Abstract

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