National trends in pediatric sepsis hospitalizations, case mix, and mortality, 2016-2022

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. We evaluated changes in hospitalizations for children with sepsis between 2016 and 2022 and investigated factors associated with in-hospital mortality.

We performed a retrospective study using the 2016, 2019, and 2022 Kids' Inpatient Database. Our population of interest was non-newborn admissions for children (<18 years) admitted to US hospitals. We reported changes in admissions for sepsis over time, changes in population-adjusted sepsis admission rates. We identified factors associated with mortality among children with sepsis in nested models.

Of 4,987,652 weighted non-newborn hospitalizations, 109,985 had sepsis. Sepsis-related admissions increased from 1.80% (95% confidence interval [CI]: 1.66%-1.94%) in 2016 to 2.57% (95% CI: 2.32%-2.81%) in 2022 (relative proportion 1.43; 95% CI: 1.25-1.60). Nationally, sepsis admissions increased from 0.43 per 1000 child-years in 2016 to 0.55 per 1000 child-years (rate ratio 1.27; 95% CI: 1.02-1.57). In-hospital mortality occurred in 4.9%. Factors positively associated with mortality included Asian or Pacific Islander (odds ratio [OR]: 1.34; 95% CI: 1.11-1.62) and Black (OR: 1.17; 95% CI: 1.05-1.31) race relative to White race, most types of medical complexity, transfer from an acute care hospital (OR: 2.21; 95% CI: 2.04-2.40) or another facility (OR 1.67; 95% CI: 1.37-2.03), and admission to an urban teaching hospital (OR 2.08; 95% CI: 1.31-3.28) or children's hospital (OR 1.90; 95% CI: 1.20-3.02) relative to a rural hospital.

Sepsis accounts for an increasing proportion of admissions and accounts for a greater number of population-adjusted hospitalizations. Variation in mortality by race suggests modifiable drivers of outcomes.