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Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice.
Pediatr Crit Care Med. 2012 Jul; 13(4):e219-26.PC

Abstract

OBJECTIVE

Pediatric patients with sepsis are identified using related but distinct criteria for clinical, research, and administrative purposes. The overlap between these criteria will affect the validity of extrapolating data across settings. We sought to quantify the extent of agreement among different criteria for pediatric severe sepsis/septic shock and to detect systematic differences between these cohorts.

DESIGN

Observational cohort study.

SETTING

Forty-two bed pediatric intensive care unit at an academic medical center.

PATIENTS

A total of 1,729 patients ≤ 18 yrs-old.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

All patients were screened for severe sepsis or septic shock using consensus guidelines (research criteria), diagnosis by healthcare professionals (clinical criteria), and International Classification of Diseases, Ninth Revision, Clinical Modification codes (administrative criteria). Cohen's κ determined the level of agreement among criteria, and patient characteristics were compared between cohorts. Ninety (5.2%) patients were identified by research, 96 (5.6%) by clinical, and 103 (6.0%) by administrative criteria. The κ ± standard error for pair-wise comparisons was 0.67 ± 0.04 for research-clinical, 0.52 ± 0.05 for research-administrative, and 0.55 ± 0.04 for clinical-administrative. Of the patients in the clinical cohort, 67% met research and 58% met administrative criteria. The research cohort exhibited a higher Pediatric Index of Mortality-2 score (median, interquartile range 5.2, 1.6-13.3) than the clinical (3.6, 1.1-6.2) and administrative (3.9, 1.0-6.0) cohorts (p = .005), an increased requirement for vasoactive infusions (74%, 57%, and 45%, p < .001), and a potential bias toward an increased proportion with respiratory dysfunction compared with clinical practice.

CONCLUSIONS

Although research, clinical, and administrative criteria yielded a similar incidence (5%-6%) for pediatric severe sepsis/septic shock, there was only a moderate level of agreement in the patients identified by different criteria. One third of patients diagnosed clinically with sepsis would not have been included in studies based on consensus guidelines or International Classification of Diseases, Ninth Revision, Clinical Modification codes. Differences in patient selection need to be considered when extrapolating data across settings.

Authors+Show Affiliations

Divisions of Critical Care, Department of Pediatrics, Children's Memorial Hospital, Chicago, IL, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22460773

Citation

Weiss, Scott L., et al. "Defining Pediatric Sepsis By Different Criteria: Discrepancies in Populations and Implications for Clinical Practice." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 13, no. 4, 2012, pp. e219-26.
Weiss SL, Parker B, Bullock ME, et al. Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. Pediatr Crit Care Med. 2012;13(4):e219-26.
Weiss, S. L., Parker, B., Bullock, M. E., Swartz, S., Price, C., Wainwright, M. S., & Goodman, D. M. (2012). Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 13(4), e219-26. https://doi.org/10.1097/PCC.0b013e31823c98da
Weiss SL, et al. Defining Pediatric Sepsis By Different Criteria: Discrepancies in Populations and Implications for Clinical Practice. Pediatr Crit Care Med. 2012;13(4):e219-26. PubMed PMID: 22460773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. AU - Weiss,Scott L, AU - Parker,Brandon, AU - Bullock,Maria E, AU - Swartz,Sheila, AU - Price,Carolynn, AU - Wainwright,Mark S, AU - Goodman,Denise M, PY - 2012/3/31/entrez PY - 2012/3/31/pubmed PY - 2012/12/10/medline SP - e219 EP - 26 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 13 IS - 4 N2 - OBJECTIVE: Pediatric patients with sepsis are identified using related but distinct criteria for clinical, research, and administrative purposes. The overlap between these criteria will affect the validity of extrapolating data across settings. We sought to quantify the extent of agreement among different criteria for pediatric severe sepsis/septic shock and to detect systematic differences between these cohorts. DESIGN: Observational cohort study. SETTING: Forty-two bed pediatric intensive care unit at an academic medical center. PATIENTS: A total of 1,729 patients ≤ 18 yrs-old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were screened for severe sepsis or septic shock using consensus guidelines (research criteria), diagnosis by healthcare professionals (clinical criteria), and International Classification of Diseases, Ninth Revision, Clinical Modification codes (administrative criteria). Cohen's κ determined the level of agreement among criteria, and patient characteristics were compared between cohorts. Ninety (5.2%) patients were identified by research, 96 (5.6%) by clinical, and 103 (6.0%) by administrative criteria. The κ ± standard error for pair-wise comparisons was 0.67 ± 0.04 for research-clinical, 0.52 ± 0.05 for research-administrative, and 0.55 ± 0.04 for clinical-administrative. Of the patients in the clinical cohort, 67% met research and 58% met administrative criteria. The research cohort exhibited a higher Pediatric Index of Mortality-2 score (median, interquartile range 5.2, 1.6-13.3) than the clinical (3.6, 1.1-6.2) and administrative (3.9, 1.0-6.0) cohorts (p = .005), an increased requirement for vasoactive infusions (74%, 57%, and 45%, p < .001), and a potential bias toward an increased proportion with respiratory dysfunction compared with clinical practice. CONCLUSIONS: Although research, clinical, and administrative criteria yielded a similar incidence (5%-6%) for pediatric severe sepsis/septic shock, there was only a moderate level of agreement in the patients identified by different criteria. One third of patients diagnosed clinically with sepsis would not have been included in studies based on consensus guidelines or International Classification of Diseases, Ninth Revision, Clinical Modification codes. Differences in patient selection need to be considered when extrapolating data across settings. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/22460773/Defining_pediatric_sepsis_by_different_criteria:_discrepancies_in_populations_and_implications_for_clinical_practice_ L2 - https://doi.org/10.1097/PCC.0b013e31823c98da DB - PRIME DP - Unbound Medicine ER -