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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
An estimate of missed pediatric sepsis in the emergency department
Christina L Cifra1, Erik Westlund2, Patrick Ten Eyck3
1University of Iowa Carver College of Medicine, Iowa City, USA.
Insights
Approximately 8.1% of pediatric severe sepsis cases in US emergency departments (EDs) may have been missed during prior treat-and-release visits. Factors like fewer chronic conditions and specific states were associated with missed pediatric sepsis diagnoses.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Health Services Research
Background:
- Timely diagnosis of pediatric sepsis is a significant clinical challenge.
- Pediatric sepsis remains a leading cause of preventable mortality and morbidity.
- Identifying missed sepsis cases in emergency departments (EDs) is crucial for improving outcomes.
Purpose of the Study:
- To estimate the incidence of potentially missed pediatric sepsis in US emergency departments.
- To identify factors associated with potentially missed sepsis cases.
Main Methods:
- Retrospective study using linked inpatient and ED administrative data from four US states.
- Identified children admitted with severe sepsis/septic shock with a prior ED treat-and-release visit within 7 days.
- Expert panel reviewed cases; multivariable regression analyzed associations with missed sepsis.
Main Results:
- Of 1945 severe sepsis/septic shock admissions, 158 (8.1%) had potentially missed sepsis in a prior ED visit.
- Increased comorbid chronic conditions were associated with lower odds of missed sepsis (OR, 0.86).
- Higher odds of missed sepsis were observed in California, Florida, and Massachusetts compared to New York.
Conclusions:
- Administrative data can effectively screen large populations for potential missed sepsis.
- This approach aids in identifying cases requiring further detailed medical record review.
- Improving sepsis recognition in EDs is essential for pediatric patient safety.
Background:
Timely diagnosis of pediatric sepsis remains elusive. We estimated the risk of potentially missed pediatric sepsis in US emergency departments (EDs) and determined factors associated with its occurrence.
Methods:
In a retrospective study of linked inpatient and ED records from four states using administrative data (excluding 40% with missing identifiers), we identified children admitted with severe sepsis and/or septic shock who had at least one ED treat-and-release visit in the 7 days prior to sepsis admission. An expert panel rated the likelihood of each ED visit being related to subsequent sepsis admission. We used multivariable regression to identify associations with potentially missed sepsis.
Results:
Of 1945 patients admitted with severe sepsis/septic shock, 158 [8.1%; 95% confidence interval (CI), 6.9%-9.4%] had potentially missed sepsis during an antecedent treat-and-release ED visit. The odds of potentially missed sepsis were lower for each additional comorbid chronic condition [odds ratio (OR), 0.86; 95% CI, 0.80-0.92] and higher in California (OR, 2.26; 95% CI, 1.34-3.82), Florida (OR, 3.33; 95% CI, 1.95-5.70), and Massachusetts (OR, 2.87; 95% CI, 1.35-6.09), compared to New York.
Conclusions:
Administrative data can be used to screen large populations for potentially missed sepsis and identify cases that warrant detailed record review.
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