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Comparison of PICU Cost and Severity-Adjusted Cost Between Patients With SIRS-Defined Sepsis and Those With
Xuepeng Zhang1,2, Kaibo Sun3, Guoyan Lu4
1Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.
Insights
The 2005 Pediatric Sepsis Consensus definition may admit low-risk patients. The Sepsis-3 criteria showed higher severity but not increased pediatric intensive care unit (PICU) costs when adjusted for illness severity.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Health economics
Background:
- The 2005 International Pediatric Sepsis Consensus definition has been criticized for lacking specificity, potentially leading to unnecessary pediatric intensive care unit (PICU) admissions.
- Comparing the cost-effectiveness of different sepsis definitions is crucial for resource allocation in pediatric critical care.
Purpose of the Study:
- To compare the PICU costs and severity-adjusted costs between pediatric patients diagnosed with sepsis using the 2005 International Pediatric Sepsis Consensus criteria versus the age-adapted Sepsis-3 criteria.
- To evaluate the economic implications of using different sepsis diagnostic criteria in a pediatric intensive care setting.
Main Methods:
- Septic children identified by the 2005 Consensus criteria were enrolled and stratified into two subgroups: those meeting the Sepsis-3 definition and those who did not.
- Severity-adjusted ICU costs (SAIC) were calculated, and linear regression analyses were performed to assess the variation in PICU costs relative to Pediatric Risk of Mortality (PRISM) scores.
- A total of 397 children were included in the analysis.
Main Results:
- Patients meeting the Sepsis-3 criteria had a longer PICU length of stay (9.0 vs. 6.0 days, P < 0.001) and higher PRISM scores and mortality.
- Despite higher severity, the Sepsis-3 group did not incur significantly higher overall or daily PICU costs when adjusted for illness severity.
- Severity-adjusted ICU costs were lower in the non-Sepsis 3.0 group (median $7,125) compared to the Sepsis 3.0 group (median $9,364), P = 0.001.
Conclusions:
- The 2005 International Pediatric Sepsis Consensus definition does not result in increased PICU costs when illness severity is taken into account.
- The Sepsis-3 criteria, while identifying more severe cases, do not appear to inflate healthcare costs in the PICU after severity adjustment.
Abstract:
Background: The 2005 International Pediatric Sepsis Consensus definition is considered to lack specificity and may lead to the admission of low-risk patients to the pediatric intensive care unit (PICU). The aim of this study was to compare the PICU cost and the severity-adjusted cost between patients with sepsis defined by the 2005 International Pediatric Sepsis Consensus and those diagnosed using the age-adapted Sepsis-3 criteria. Methods: Septic children identified by the 2005 Consensus were screened for enrollment. The enrolled children were stratified into two subgroups using the age-adapted Sepsis 3.0 definition. A comparison was made between the subgroups of sepsis 3.0-defined children and non-sepsis 3.0-defined septic children. The Severity Adjusted ICU Cost (SAIC) was used to evaluate the case-mixed severity-adjusted costs of the study population. Coefficients in linear regression analyses in subgroups were calculated for presenting variation of PICU costs for every unit change of PRISM score. Results: A total of 397 children were enrolled. The PICU length of stay was longer in the sepsis 3.0 group than in the non-sepsis 3.0 group [median (IQR), 9.0 (5.0, 15.0) vs. 6.0 (3.0, 9.0); P < 0.001]. Pediatric risk of mortality (PRISM) scores and mortality were significantly higher in sepsis 3.0-defined septic patients. The total costs and daily costs in the PICU were both significantly lower in the non-sepsis 3.0 group (P < 0.001). The severity-adjusted ICU cost in the non-sepsis 3.0 group was lower than that in the sepsis 3.0 group [median (IQR), 7,125 (3,588, 11,134) vs. 9,364 (5,680, 15,876); P = 0.001]. There was no significant difference among the regression coefficients. Conclusions: The 2005 International Pediatric Sepsis Consensus definition does not lead to more PICU costs after considering illness severity. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03598127.
