Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study

Schlapbach, Luregn J.; Straney, Lahn; Alexander, Janet; MacLaren, Graeme; Festa, Marino S.; Schibler, Andreas; Slater, Anthony

doi:10.1016/s1473-3099(14)71003-5

Cited by 276 publications

(253 citation statements)

References 40 publications

(16 reference statements)

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“…In most high-income countries, access to care, vaccination campaigns and improvement in intensive care have drastically decreased deaths from infection. Similar to adults, recent paediatric studies have shown an increase in the incidence of invasive infection and septic shock and a relative decrease in mortality [2–4]. …”

Section: Introductionmentioning

confidence: 99%

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

et al. 2016

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PurposeAlthough overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts’ definition of paediatric RSS.MethodsWe conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality).ResultsFrom the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89–0.94), and 0.956 (95 % CI 0.93–0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality.ConclusionsThis ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

et al. 2016

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“…[6] The in-hospital mortality associated with sepsis was 25% globally (irrespective of age), 24% in North America, Europe, and Australia/New Zealand, and 31% in Asia, Africa, and South America. [5] A retrospective observational study by Schlapbach et al [7] found that the mortality rates associated with sepsis and septic shock were 5.6% and 17.0%, respectively, in critically ill children in Australia and New Zealand. Consequently, sepsis poses a serious threat to human health, although recent research has shown that the mortality related to sepsis has been decreasing.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a mortality risk model for pediatric sepsis

Chen

et al. 2017

Medicine

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Pediatric sepsis is a burdensome public health problem. Assessing the mortality risk of pediatric sepsis patients, offering effective treatment guidance, and improving prognosis to reduce mortality rates, are crucial.We extracted data derived from electronic medical records of pediatric sepsis patients that were collected during the first 24 hours after admission to the pediatric intensive care unit (PICU) of the Hunan Children's hospital from January 2012 to June 2014. A total of 788 children were randomly divided into a training (592, 75%) and validation group (196, 25%). The risk factors for mortality among these patients were identified by conducting multivariate logistic regression in the training group. Based on the established logistic regression equation, the logit probabilities for all patients (in both groups) were calculated to verify the model's internal and external validities.According to the training group, 6 variables (brain natriuretic peptide, albumin, total bilirubin, D-dimer, lactate levels, and mechanical ventilation in 24 hours) were included in the final logistic regression model. The areas under the curves of the model were 0.854 (0.826, 0.881) and 0.844 (0.816, 0.873) in the training and validation groups, respectively.The Mortality Risk Model for Pediatric Sepsis we established in this study showed acceptable accuracy to predict the mortality risk in pediatric sepsis patients.

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“…Risk factors associated with ICU muscle wasting and weakness in adults-sepsis (21,23), organ dysfunction (21), prolonged mechanical ventilation (21), acute lung injury (20), hyperglycemia (24), and high corticosteroid dose (21)-also affect children (25)(26)(27)(28)(29), raising the possibility of muscle wasting and corresponding physical impairment following critical illness in children. Transient physical impairments, such as motor delays or lowered ability to perform daily activities, may not be alarming if children can eventually catch up to their peers.…”

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confidence: 99%

Functional Outcomes and Physical Impairments in Pediatric Critical Care Survivors: A Scoping Review*

Ong

Lee

Leow

et al. 2016

Pediatric Critical Care Medicine

131

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Functional impairment may be persistent in pediatric survivors of critical care. Unfortunately, studies varied largely in measurement timing and tools used. The lack of differentiation between impairment in different functional domains limited the generalizability of data. Further studies using a combination of standardized measures at various time points of the disease process can help establish more comprehensive rates of physical impairment.

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Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study

Cited by 276 publications

References 40 publications

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

Development and validation of a mortality risk model for pediatric sepsis

Functional Outcomes and Physical Impairments in Pediatric Critical Care Survivors: A Scoping Review*

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