Pediatric Severe Sepsis in U.S. Children’s Hospitals*

Abstract

Objective-To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Design-Observational cohort study from 2004-2012.Setting-Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database.Patients-Children ≤18 years of age.Measurements and Main Results-We identified patients with severe sepsis or septic shock by using two International Classification of Diseases, 9 th edition-Clinical Modification (ICD9-CM) based coding strategies: 1) combinations of ICD9-CM codes for infection plus organ dysfunction (combination code cohort); 2) ICD9-CM codes for severe sepsis and septic shock (sepsis code cohort). Outcomes included prevalence of severe sepsis, as well as hospital and intensive care unit (ICU) length of stay (LOS), and mortality. Outcomes were compared between the two cohorts examining aggregate differences over the study period and trends over time. The combination code cohort identified, 176,124 hospitalizations (3.1% of all hospitalizations), while the sepsis code cohort identified 25,236 hospitalizations (0.45%), a 7-fold difference. Between 2004 and 2012, the prevalence of sepsis increased from 3.7% to 4.4% using the combination code cohort and from 0.4% to 0.7% using the sepsis code cohort (p<0.001 for trend in each cohort). LOS (hospital and ICU) and costs decreased in both cohorts over the study period (p<0.001). Overall hospital mortality was higher in the sepsis code cohort than the combination code cohort (21.2%,. Over the 9 year study period, there was an absolute reduction in mortality of 10.9% (p<0.001) in the sepsis code cohort and 3.8% (p<0.001) in the combination code cohort.Conclusions-Prevalence of pediatric severe sepsis increased in the studied US children's hospitals over the past 9 years, though resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to 7-fold depending on the strategy used for case ascertainment.

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

“…This finding contrasts with reports of several large epidemiological studies of pediatric sepsis with mortality rates closer to 4-10% (1,4,43). However, these studies used International Classification of Diseases, Ninth Revision (ICD-9), codes, which have been shown to capture a lower severity of illness and thereby underestimate mortality (5,7). In a recent database study using expanded ICD-9 coding, researchers reported a PICU mortality of 26.4% (6), and authors of prospective studies have reported short-term mortality rates up to 24% (2,5,19,46,47).…”

“…Vasoactive medications were used in 55%, with significant variation across age groups (P = 0.01) and the highest use in infants aged 29 days to 1 year (see Table E3). Vasoactive medications were used for a median of 7 (IQR,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) days. Epinephrine and norepinephrine were the most commonly used medications, at 43% and 42% of patients treated with vasoactive medications, respectively, and dopamine was used in 32%.…”

“…It is estimated that over one-third of children who die in tertiary care PICUs within the United States have severe sepsis (6). Recent reports of a rising prevalence of pediatric sepsis (1,6,7) may reflect an expanding vulnerable population with chronic comorbidities (8,9), increasing rates of multidrug-resistant organisms and opportunistic infections (10,11), and a surge in sepsis surveillance (12,13). However, shifting patterns of diagnostic coding may confound current epidemiological estimates that are based largely on retrospectively identified cases in administrative databases (5,14), and prior studies using prospective case identification have been limited to few sites within single countries, thus precluding broad generalizations (2,5,15).…”

Діагностична Цінність Сучасних Біомаркерів Розвитку Гнійно-Бактеріальних Захворювань У Дітей

“…Згідно з даними Fran Balamuth та інших (2014), середня вартість лікування однієї дитини віком понад 2 місяці у лікар-нях США становила 78,946 долара, загальні витрати на лікування сепсису на рік - 4,8 млн доларів США [9]. В Європі терапія сепсису оцінюється в 70-90 тис.…”

Surviving sepsis campaign in children

“…Several studies reported a poor adherence to the recommendations, others, with Introduction Le sepsis grave de l'enfant est fréquent et son traitement, dans toutes les études pédiatriques, est loin d'être optimal [1][2][3], ce qui explique une mortalité encore très élevée particulièrement dans les pays ou régions ayant peu de ressources. Aux États-Unis, le taux de mortalité à l'hôpital du sepsis grave est de 2 % chez les enfants bien portants et de 8 % chez les enfants atteints de maladie chronique [4], celui du choc septique peut atteindre 30 % [5,6]. Au Royaume-Uni, le système de transport régional de Londres a rapporté, pour la période 2005-2011 et sur un collectif de 627 enfants, une mortalité de 21 % (54 % en cas de comorbidité associée, 16 % sans) ; 5 % des enfants décédaient avant l'arrivée en réanimation et 11 % dans les 24 premières heures [7].…”