Readmission and Late Mortality After Pediatric Severe Sepsis

Czaja, Angela S.; Zimmerman, Jerry J.; Nathens, Avery B.

doi:10.1542/peds.2008-0856

Cited by 92 publications

(95 citation statements)

References 24 publications

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“…Moreover, hospital mortality, often considered to be too low to practically study in pediatric severe sepsis, was 25% and exceeded prior epidemiological estimates that relied on retrospective administrative data (1,4,43). As in other studies, comorbid conditions were common (1,5,6,18,(44)(45)(46), and children with immunosuppressive conditions and preexisting renal disease exhibited the highest mortality. However, we could not determine whether death was attributable to sepsis or to an underlying comorbid Definition of abbreviations: ECMO = extracorporeal membrane oxygenation; G/GM-CSF = granulocyte/granulocyte-monocyte colony-stimulating factor; IVIG = intravenous immunoglobulin; RRT = renal replacement therapy.…”

Section: Discussionmentioning

confidence: 70%

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

Weiss

Fitzgerald

Pappachan

et al. 2015

Am J Respir Crit Care Med

786

613

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Rationale: Limited data exist about the international burden of severe sepsis in critically ill children.Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials.Methods: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator-and vasoactive-free days at Day 28, functional status, and mortality.Measurements and Main Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resourcelimited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group.Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.

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Section: Discussionmentioning

confidence: 70%

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

Weiss

Fitzgerald

Pappachan

et al. 2015

Am J Respir Crit Care Med

786

613

View full text Add to dashboard Cite

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“…3. The median time to readmission for all patients was 7 days (IQR, [4][5][6][7][8][9][10][11][12][13][14], and this was significantly different between treatment groups (uncomplicated appendectomy, 7 days [IQR, [3][4][5][6][7][8][9][10][11][12][13]; complicated appendectomy, 7 days [IQR, [4][5][6][7][8][9][10][11][12][13]; drainage without appendectomy, 10 days [IQR, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; antibiotics only, 10 days [IQR, [4]…”

Section: Incidence Timing and Principal Diagnoses Associated With Rmentioning

confidence: 99%

“…In this regard, hospital readmission is increasingly being targeted as a marker for quality of care and reimbursement reform [3][4][5][6][7][8][9]. Although the etiology and, to a lesser degree, the financial ramifications of hospital readmissions have been explored in other areas of pediatrics, there are limited data pertaining to the epidemiology and financial impact of readmissions associated with common pediatric surgical diseases [10][11][12][13][14][15][16][17][18]. In general pediatric surgery, acute appendicitis may be a potentially high-impact area for targeting preventable readmissions, given the relatively high prevalence of the disease and associated postdischarge complication rates [19][20][21].…”

mentioning

confidence: 99%

Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications

Rice-Townsend

Hall

Barnes

et al. 2012

Journal of Pediatric Surgery

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“…Pediatric sepsis is still one of the major life-threatening diseases in children worldwide [1,2]. The incidence of pediatric sepsis is higher in developing country where pathogens readily invade children because of low birth weight, water and air pollution as well as insufficient immunization and nutrition [3,4].…”

Section: Introductionmentioning

confidence: 99%

Gene Network for Identifying the Entropy Changes of Different Modules in Pediatric Sepsis

Yang

Zhang²

2016

Cell Physiol Biochem

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Background/Aims: Pediatric sepsis is a disease that threatens life of children. The incidence of pediatric sepsis is higher in developing countries due to various reasons, such as insufficient immunization and nutrition, water and air pollution, etc. Exploring the potential genes via different methods is of significance for the prevention and treatment of pediatric sepsis. This study aimed to identify potential genes associated with pediatric sepsis utilizing analysis of gene network and entropy. Methods: The mRNA expression in the blood samples collected from 20 septic children and 30 healthy controls was quantified by using Affymetrix HG-U133A microarray. Two condition-specific protein-protein interaction networks (PINs), one for the healthy control and the other one for the children with sepsis, were deduced by combining the fundamental human PINs with gene expression profiles in the two phenotypes. Subsequently, distinct modules from the two conditional networks were extracted by adopting a maximal clique-merging approach. Delta entropy (ΔS) was calculated between sepsis and control modules. Results: Then, key genes displaying changes in gene composition were identified by matching the control and sepsis modules. Two objective modules were obtained, in which ribosomal protein RPL4 and RPL9 as well as TOP2A were probably considered as the key genes differentiating sepsis from healthy controls. Conclusion: According to previous reports and this work, TOP2A is the potential gene therapy target for pediatric sepsis. The relationship between pediatric sepsis and RPL4 and RPL9 needs further investigation.

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Readmission and Late Mortality After Pediatric Severe Sepsis

Cited by 92 publications

References 24 publications

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

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

Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications

Gene Network for Identifying the Entropy Changes of Different Modules in Pediatric Sepsis

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