Health-Related Quality of Life Among Survivors of Pediatric Sepsis*

Abstract

Objective: Mortality from pediatric sepsis has steadily declined over the past several decades, however little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis. Design: Retrospective cohort study Setting: Seattle Children's Hospital Patients: Children aged 1 month to 21 years admitted to the inpatient wards or intensive care units from 2012-2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization, and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available Interventions: None Measurements and Main Results: We assessed health-related quality of life with the Pediatric Quality of Life Inventory™ for pre-admission baseline, admission, and post-discharge (median 31 days) status. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline at follow-up (the minimum clinically significant difference between two scores). Of 790 patients, 23.8% failed to recover to baseline health-related quality of life at follow-up. Factors associated with failure to recover were septic shock, older age, private insurance, complex chronic disease, immune compromise, central nervous system infection or bacteremia, intensive care unit admission, and longer length of stay. On multivariable analysis controlling for time to follow-up, failure to recover was independently

Priority Outcomes in Critically Ill Children: A Patient and Parent Perspective

“…Emerging PICU trials are therefore evolving from selecting mortality or physiological primary end points to measuring functional outcomes and HRQoL. [30][31][32] Measuring patientcentered outcomes in critical care trials is complex; there is a tendency to oversimplify and represent a complex, multidimensional construct with a composite measure or score. Current work is underway engaging researchers as well as patient and family stakeholders to develop core outcomes sets and determine how best to measure them in PICU studies.…”

The Prevalence, Risk Factors, and Outcomes of Sepsis in Critically Ill Patients in China: A Multicenter Prospective Cohort Study

“…Sepsis is a major challenge for public health; it is the main cause of morbidity and mortality in intensive care units (ICUs) and is associated with poor outcomes (1)(2)(3)(4). In the United States, the incidence of sepsis is 535 cases per 100,000 person-years and is increasing (5).…”

There is an urgent need for evidence-based internationally agreed guidelines for minimising readmissions after paediatric sepsis

“…Incidence of death was similar—6.8% (during sentinel admission or <28 days of discharge) as compared with 6.5% at a later date 3. A retrospective cohort study between 2012 and 2015 from Seattle Children’s Hospital, USA, involving 790 children admitted for community-acquired sepsis highlighted that nearly one-quarter surviving hospitalisation experienced a clinically significant deterioration in health-related quality of life 5…”

“…There is an urgent need for evidence-based internationally agreed guidelines for minimising post-sepsis readmissions through identification of potentially preventable factors, robust discharge criteria, appropriate parental education and strategies for improving quality of life. This may be achieved through an internationally agreed consensus paper taking into account various available studies/guidelines 1–5. In practice, such consensus paper will contribute towards educating the clinicians when managing severe sepsis and ensure delivery of optimum care.…”