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Association between hospital case volume and mortality in pediatric sepsis: A retrospective observational study using
Shingo Ohki1,2, Makoto Otani3, Shinichi Tomioka1,4
1Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Insights
Treatment at high-volume hospitals (HVHs) significantly reduces in-hospital mortality for pediatric sepsis patients. This study highlights the importance of hospital case volume in improving survival rates for critically ill children with sepsis.
Area of Science:
- Pediatric critical care medicine
- Hospital quality and outcomes research
- Infectious diseases and epidemiology
Background:
- Pediatric sepsis is a major cause of child mortality.
- High-volume hospitals (HVHs) are associated with better outcomes for various pediatric conditions.
- The impact of hospital volume on pediatric sepsis outcomes is not well-established.
Purpose of the Study:
- To investigate the association between hospital case volume and in-hospital mortality rates in pediatric sepsis.
- To determine if treatment at HVHs impacts survival for children with sepsis.
Main Methods:
- Retrospective cohort study using the Diagnosis Procedure Combination database (April 2014 - March 2018).
- Included pediatric patients (28 days to 17 years) with sepsis requiring organ support and timely blood cultures/antimicrobials.
- Hospitals categorized as high-volume (HVH) or low-volume (LVH); propensity score matching used for analysis.
Main Results:
- 934 pediatric sepsis patients analyzed; overall in-hospital mortality was 16.1%.
- 234 patients treated at 5 HVHs; 700 patients treated at 234 LVHs.
- Propensity score-matched analysis showed significantly lower in-hospital mortality odds at HVHs (OR, 0.42; P=0.008).
Conclusions:
- Treatment at high-volume hospitals is associated with reduced in-hospital mortality in pediatric sepsis.
- Hospital case volume may be a critical factor in improving survival for pediatric sepsis.
- Findings suggest a potential benefit of centralizing pediatric sepsis care at specialized centers.
Introduction:
The survival benefits of treatment at high-volume hospitals (HVHs) are well-documented for several critical pediatric conditions. However, their impact on pediatric sepsis, a leading cause of mortality among children, remains understudied.
Aim Of The Study:
To investigate the association between hospital case volume and mortality rates in pediatric sepsis.
Material And Methods:
We conducted a retrospective cohort study using data from the Diagnosis Procedure Combination database. The study included patients who met the following criteria: 1) aged 28 days to 17 years; 2) discharged from the hospital between April 2014 and March 2018; 3) had a sepsis diagnosis coded under the International Classification of Diseases, 10th revision; 4) underwent blood cultures on hospital admission day (day 0) or day 1; 5) received antimicrobial agents on day 0 or 1; and 6) required at least one organ support measure (e.g., mechanical ventilation or vasopressors) on day 0 or 1. Hospitals were categorized by case volume during the study period, with HVHs defined as those in the highest quartile and low-volume hospitals (LVHs) as those in the remaining quartiles. In-hospital mortality rates between HVH and LVH groups were compared using mixed-effects logistic regression analysis with propensity score (PS) matching.
Results:
A total of 934 pediatric patients were included in the study, with an overall in-hospital mortality rate of 16.1%. Of them, 234 were treated at 5 HVHs (≥26 patients in 4 years), and 700 at 234 LVHs (<26 patients in 4 years). Upon PS matching, patients treated at HVHs demonstrated significantly lower odds of in-hospital mortality compared with those treated at LVHs (odds ratio, 0.42; 95% confidence interval, 0.22-0.80; P = 0.008).
Conclusions:
In pediatric patients with sepsis, treatment at HVHs was associated with lower odds of in-hospital mortality.
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