Evaluating Pediatric Sepsis Definitions Designed for Electronic Health Record Extraction and Multicenter Quality...

Area of Science:

• Pediatric critical care medicine
• Healthcare quality improvement
• Epidemiology of infectious diseases

Background:

• Pediatric sepsis remains a significant cause of morbidity and mortality in children.
• Standardized definitions are crucial for accurate identification, research, and quality improvement initiatives in pediatric sepsis care.
• The Children's Hospital Association (CHA) developed specific sepsis definitions for their Improving Pediatric Sepsis Outcomes (IPSO) collaborative.

Purpose of the Study:

• To describe the CHA's IPSO sepsis definitions and the characteristics of identified pediatric patients.
• To evaluate the performance of these sepsis definitions using a validated framework.
• To assess the feasibility and utility of these definitions for multicenter quality improvement efforts.

Main Methods:

• An observational cohort study was conducted across 46 hospitals participating in the CHA's IPSO collaborative from January 2017 to December 2018.
• Patients were identified using electronic health record (EHR) data based on CHA's sepsis and critical sepsis definitions.
• The definitions were evaluated across domains including reliability, validity (content, construct, criterion), measurement burden, and timeliness.

Main Results:

• Forty hospitals met data quality criteria, identifying 23,976 cases of IPSO Sepsis and 8,565 of IPSO Critical Sepsis.
• Patients identified were diverse, with 43% being immunosuppressed/immunocompromised, and significant proportions requiring intensive care (60.8%), ventilation (26.4%), or vasopressors (19.7%).
• The definitions showed strengths in content validity, construct validity, and criterion validity but had weaknesses in reliability. Initial measurement burden was high, but timeliness improved over time.

Conclusions:

• The IPSO sepsis definitions demonstrated feasibility for large-scale data abstraction and aggregation across multiple institutions.
• The identified patient cohort provides valuable insights into the characteristics of children treated for sepsis.
• Operationalizing these definitions supports multicenter identification and data aggregation, indicating practical utility for pediatric sepsis quality improvement.