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Resource Use and Outcomes for Children Hospitalized With Severe Sepsis or Septic Shock
Folafoluwa O Odetola1, Achamyeleh Gebremariam2
1Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Insights
Pediatric severe sepsis or septic shock significantly impacts children, with 17% mortality and high costs. Age, comorbidities, and organ dysfunction are key factors influencing outcomes and resource use.
Area of Science:
- Pediatric critical care medicine
- Health services research
Background:
- Severe sepsis and septic shock in children are life-threatening conditions requiring intensive care.
- Outcomes and resource utilization for pediatric severe sepsis/septic shock can vary significantly based on patient and hospital factors.
Purpose of the Study:
- To identify patient and hospital characteristics associated with in-hospital mortality, length of stay (LOS), and healthcare charges for children with severe sepsis or septic shock.
- To understand the impact of specialized organ-supportive technology on outcomes and resource use in this vulnerable population.
Main Methods:
- A retrospective analysis of the 2012 Kids' Inpatient Database was conducted.
- Multivariate regression models were employed to determine factors associated with mortality, LOS, and charges in pediatric severe sepsis/septic shock cases.
Main Results:
- The study analyzed 11,972 hospitalizations for pediatric severe sepsis or septic shock, with 17% in-hospital mortality, an average LOS of 24 days, and average charges of $314,950.
- Higher mortality was linked to neonates, cumulative organ dysfunction, comorbidities, and cardiopulmonary resuscitation.
- Longer LOS and higher charges were associated with neonates, comorbidities, higher illness severity, invasive medical technology use, and urban hospital settings.
Conclusions:
- Age-specific strategies are crucial for managing pediatric severe sepsis/septic shock, focusing on comorbidities and organ dysfunction to improve outcomes.
- Further research is needed to understand the drivers of higher resource utilization in urban hospitals for these critically ill children.
Objective:
To describe patient and hospital characteristics associated with in-hospital mortality, length of stay (LOS), and charges for children with severe sepsis or septic shock who often require specialized organ-supportive technology to enhance outcomes, availability of which might vary across hospitals.
Design:
Retrospective study among children hospitalized for severe sepsis or septic shock, using the 2012 Kids' Inpatient Database. Multivariate regression methods identified factors associated with mortality, LOS, and charges.
Measurements And Main Results:
Of an estimated 11 972 hospitalizations for pediatric severe sepsis or septic shock, most hospitalizations (85%) were to urban teaching hospitals. Hospitalizations were more frequent among neonates and older adolescents than other age groups. Mortality was 17%, average LOS was 24 days, and average hospital charges were US$314 950. Higher mortality was associated with neonates, cumulative organ dysfunction, more comorbidities, and cardiopulmonary resuscitation. Longer hospitalization and higher charges were associated with neonates, more comorbidities, higher illness severity, invasive medical technology, and urban hospitals.
Conclusions:
Efforts to mitigate the substantial in-hospital mortality and resource use observed in pediatric severe sepsis or septic shock should be age-specific and focused on the influence of comorbidities and organ dysfunction on outcomes. Future research should elucidate reasons for higher resource use at urban hospitals.
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