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

Objectives: To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Design: Observational cohort study from 2004 to 2012. Setting: Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database. Patients: Children 18 years old or younger. Measurements and Main Results: We identified patients with severe sepsis or septic shock by using two International Classification of Diseases, 9th edition, Clinical Modification–based coding strategies: 1) combinations of International Classification of Diseases, 9th edition, Clinical Modification codes for infection plus organ dysfunction (combination code cohort); 2) International Classification of Diseases, 9th edition, Clinical Modification codes for severe sepsis and septic shock (sepsis code cohort). Outcomes included prevalence of severe sepsis, as well as hospital and ICU length of stay, 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), whereas the sepsis code cohort identified 25,236 hospitalizations (0.45%), a seven-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). Length of stay (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% [95% CI, 20.7–21.8] vs 8.2% [95% CI, 8.0–8.3]). 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 U.S. children’s hospitals over the past 9 years, whereas resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to seven-fold depending on the strategy used for case ascertainment.

[1]  S. Bratton.  Corticosteroids and Mortality in Children With Bacterial Meningitis , 2008 .

[2]  G. Larsen,et al.  An Emergency Department Septic Shock Protocol and Care Guideline for Children Initiated at Triage , 2011, Pediatrics.

[3]  D. Cutler,et al.  Mortality reduction among pneumonia patients still substantial despite the impact of coding changes. , 2013, The American journal of medicine.

[4]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[5]  P. Mody,et al.  Spending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations. , 2013, Journal of hospital medicine.

[6]  T D Koepsell,et al.  Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. , 2001, Pediatrics.

[7]  A. Cruz,et al.  Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department , 2011, Pediatrics.

[8]  P. Loy.  International Classification of Diseases--9th revision. , 1978, Medical record and health care information journal.

[9]  Raina Paul,et al.  Adherence to PALS Sepsis Guidelines and Hospital Length of Stay , 2012, Pediatrics.

[10]  A. Randolph,et al.  International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[11]  Peter K Lindenauer,et al.  Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009. , 2012, JAMA.

[12]  J. Marshall,et al.  Sepsis: rethinking the approach to clinical research , 2008, Journal of leukocyte biology.

[13]  Simon Nadel,et al.  Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine* , 2009, Critical care medicine.

[14]  S. Geroulanos,et al.  Historical perspective of the word “sepsis” , 2006, Intensive Care Medicine.

[15]  Gilles Clermont,et al.  The epidemiology of severe sepsis in children in the United States. , 2003, American journal of respiratory and critical care medicine.

[16]  Mark D. Williams,et al.  Drotrecogin alfa (activated) in children with severe sepsis: a multicentre phase III randomised controlled trial , 2007, The Lancet.

[17]  Jason Fine,et al.  Sample size for positive and negative predictive value in diagnostic research using case-control designs. , 2008, Biostatistics.

[18]  M. Wainwright,et al.  Defining pediatric sepsis by different criteria: Discrepancies in populations and implications for clinical practice , 2012, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[19]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012 , 2013, Intensive Care Medicine.

[20]  G. Freed,et al.  Patient and Hospital Correlates of Clinical Outcomes and Resource Utilization in Severe Pediatric Sepsis , 2007, Pediatrics.

[21]  Mitchell M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive Care Medicine.

[22]  D. Angus,et al.  Trends in the Epidemiology of Pediatric Severe Sepsis* , 2013, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[23]  J. Jaramillo-Bustamante,et al.  Epidemiology of sepsis in pediatric intensive care units: First Colombian Multicenter Study* , 2012, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[24]  B. Carr,et al.  Benchmarking the Incidence and Mortality of Severe Sepsis in the United States* , 2013, Critical care medicine.

[25]  S. Pon,et al.  Mortality Rates in Pediatric Septic Shock with and without Multiple Organ System Failure Methods and Materials , 2022 .

[26]  J. Carcillo,et al.  [Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock]. , 2002, Jornal de pediatria.