Related Experiment Video
Updated: Dec 9, 2025
A Data-Driven Approach to Quantifying Immune States in Sepsis
Published on: February 7, 2025
Evaluating Pediatric Sepsis Definitions Designed for Electronic Health Record Extraction and Multicenter Quality
Halden F Scott1,2, Richard J Brilli3, Raina Paul4
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Insights
The Children's Hospital Association's pediatric sepsis definitions are feasible for large-scale data, aiding quality improvement. While reliable identification of pediatric sepsis cases requires further refinement, the definitions show practical utility.
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.
Objectives:
To describe the Children's Hospital Association's Improving Pediatric Sepsis Outcomes sepsis definitions and the identified patients; evaluate the definition using a published framework for evaluating sepsis definitions.
Design:
Observational cohort.
Setting:
Multicenter quality improvement collaborative of 46 hospitals from January 2017 to December 2018, excluding neonatal ICUs.
Patients:
Improving Pediatric Sepsis Outcomes Sepsis was defined by electronic health record evidence of suspected infection and sepsis treatment or organ dysfunction. A more severely ill subgroup, Improving Pediatric Sepsis Outcomes Critical Sepsis, was defined, approximating septic shock.
Interventions:
Participating hospitals identified patients, extracted data, and transferred de-identified data to a central data warehouse. The definitions were evaluated across domains of reliability, content validity, construct validity, criterion validity, measurement burden, and timeliness.
Measurements And Main Results:
Forty hospitals met data quality criteria across four electronic health record platforms. There were 23,976 cases of Improving Pediatric Sepsis Outcomes Sepsis, including 8,565 with Improving Pediatric Sepsis Outcomes Critical Sepsis. The median age was 5.9 years. There were 10,316 (43.0%) immunosuppressed or immunocompromised patients, 4,135 (20.3%) with central lines, and 2,352 (11.6%) chronically ventilated. Among Improving Pediatric Sepsis Outcomes Sepsis patients, 60.8% were admitted to intensive care, 26.4% had new positive-pressure ventilation, and 19.7% received vasopressors. Median hospital length of stay was 6.0 days (3.0-13.0 d). All-cause 30-day in-hospital mortality was 958 (4.0%) in Improving Pediatric Sepsis Outcomes Sepsis; 541 (6.3%) in Improving Pediatric Sepsis Outcomes Critical Sepsis. The Improving Pediatric Sepsis Outcomes Sepsis definitions demonstrated strengths in content validity, convergent construct validity, and criterion validity; weakness in reliability. Improving Pediatric Sepsis Outcomes Sepsis definitions had significant initial measurement burden (median time from case completion to submission: 15 mo [interquartile range, 13-18 mo]); timeliness improved once data capture was established (median, 26 d; interquartile range, 23-56 d).
Conclusions:
The Improving Pediatric Sepsis Outcomes Sepsis definitions demonstrated feasibility for large-scale data abstraction. The patients identified provide important information about children treated for sepsis. When operationalized, these definitions enabled multicenter identification and data aggregation, indicating practical utility for quality improvement.
More Related Videos
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
05:28Evaluation of a Reliable Biomarker in a Cecal Ligation and Puncture-Induced Mouse Model of Sepsis
Published on: December 9, 2022
Related Concept Videos
01:30Methods of Documentation VII: EMR
01:10Documentation of Nursing Diagnosis
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:21Methods of Documentation III: PIE
01:15Nursing Evaluation