Sepsis in Canadian children: a national analysis using administrative data

Abstract

BackgroundSevere infection resulting in sepsis is recognized as a leading cause of morbidity and mortality worldwide. The purpose of this study is to use longitudinal, population-based data to report national-level hospital metrics, providing a current assessment of the status of sepsis hospitalizations in Canadian children.MethodsWe performed an analysis of previously abstracted data from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD). Children aged 0–17 years at the time of hospital admission were identified from a cohort of patients with sepsis or severe sepsis using the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-CA) and the Canadian Classification of Health Interventions (CCI). Descriptive population-based statistics are reported.ResultsHospitalization data for 20,130 children admitted over 5 years were reviewed. The majority of children were young, with neonates (56.3%) and infants under 2 months (18.8%) representing the majority of cases. A decline in age-adjusted hospitalization rates was demonstrated in both overall and non-severe sepsis across the study period; however, no change was demonstrated for severe sepsis. While overall in-hospital crude mortality rates did not change significantly across the study period (range 5.1%–5.4%), a significant decrease was found in children aged 3–23 months and adolescents. Multi-organ failure was reported in more than one-quarter of children with severe sepsis. Odds of mortality increased significantly with number of organs failed.ConclusionSepsis remains an important cause of morbidity and mortality in Canadian children, posing a significant burden on health care resources. Age continues to be associated with the incidence and severity of illness. Overall hospitalization rates have declined over time, as has mortality in severe sepsis. This report provides baseline metrics for future outcome-based research in Canada targeting prevention strategies and early diagnosis, as well as therapies preventing and managing organ failure.

Epidemiologia da sepse em crianças internadas em unidades de terapia intensiva pediátrica da América Latina

“…Os dados da literatura apontam que a sepse pediátrica é uma doença bastante prevalente tanto em países desenvolvidos quanto em desenvolvimento, sendo que nestes últimos a sepse representa um problema médico, social e econômico mais grave 11,16,19,21,23,27,29,42,53,54,[56][57][58][59][60] . O aumento da frequência de sepse relacionada a infecções virais, observado em estudos recentes de sepse pediátrica, alerta para a importância de iniciativas que visem à redução da ocorrência e da disseminação de doenças infectocontagiosas, incluindo as virais.…”

“…Os resultados do presente estudo diferem daqueles estudos, uma vez que não foram observadas tais associações, seja no que se refere à mortalidade dos lactentes seja com relação ao gênero masculino. ,27,30,57,58 . No estudo de Typpo et al109 , a presença de DMOS durante as primeiras 24 horas de internação na UTIP aumentou 11 vezes a chance de óbito de crianças sépticas.…”

Epidemiology of Pediatric Septic Shock

“…Also using administrative data from hospital record systems, Thompson and Kissoon 22 reported that between 2004 and 2009, sepsis accounted for 4,000 hospital admissions of children and 200 deaths per year in Canada. Among children with sepsis, 22% had severe sepsis.…”

“…The mortality from severe sepsis and septic shock in these countries remains high. [22][23][24][25] A study from Italy 23 reported a 51% mortality rate from septic shock, and 30.6% rate of early mortality (<24 hours). The high mortality from septic shock in Italian PICUs was attributed to the inadequate treatment of shock, because in the study period, none of the PICUs adopted the algorithm for severe sepsis and septic shock treatment in children proposed by American College of Critical Care Medicine -Pediatric Advanced Life Support.…”

Burden of Paediatric Sepsis in a Tertiary Centre from a Developing Country

“…Mortality is highest in low-and middleincome countries (LMICs), with five million deaths annually, where poor socio-economic circumstances, limited access to care and non-resilient health systems result in worst outcomes (2). Recent estimates from the United States of America (USA), Canada, Australia, China, India and Europe showed a rising incidence and high mortality rates in children (2)(3)(4)(5)(6)(7).…”