Application of the Improving Pediatric Sepsis Outcomes Definition for Pediatric Sepsis to Nationally Representative...

Area of Science:

• Pediatric Emergency Medicine
• Critical Care
• Health Services Research

Background:

• Pediatric sepsis is a life-threatening condition requiring timely diagnosis and treatment.
• Accurate identification of pediatric sepsis cases in administrative datasets is crucial for research and quality improvement.

Purpose of the Study:

• To compare encounter estimates and patient demographics for pediatric sepsis using modified Improving Pediatric Sepsis Outcomes (IPSO) criteria versus other established criteria.
• To evaluate the characteristics of pediatric sepsis cohorts identified through different ascertainment methods in administrative data.

Main Methods:

• Analysis of the National Hospital Ambulatory Medical Care Survey (2003-2018) data.
• Comparison of three pediatric sepsis criteria: modified IPSO, explicit diagnostic codes, and implicit severe sepsis.
• Reporting of encounter estimates, demographics, and treatments for each cohort.

Main Results:

• Modified IPSO criteria yielded the highest yearly encounter estimate (116,200), followed by severe sepsis (56,000) and explicit criteria (27,900).
• The modified IPSO cohort showed high rates of antibiotics, IV fluids, and blood cultures. The explicit criteria cohort had high admission rates but lower diagnostic test utilization.
• The severe sepsis definition identified the fewest cases and had the lowest rates of blood cultures and admissions.

Conclusions:

• Different criteria for identifying pediatric sepsis in administrative data result in substantially different encounter estimates and cohort characteristics.
• The modified IPSO criteria identified a higher acuity population compared to the severe sepsis definition, but lower acuity than the explicit criteria cohort.