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Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database.
Pediatr Crit Care Med. 2014 Nov; 15(9):828-38.PC

Abstract

OBJECTIVE

To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization.

DESIGN

Retrospective review of a prospectively collected multi-institutional children's hospital database.

SETTING

PICUs in 43 U.S. children's hospitals.

PATIENTS

PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data from the Pediatric Health Information System database collected by the Children's Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8-36 d) and PICU length of stay of 7 days (interquartile range, 2-17 d), with median cost/day of $4,516 and median total hospitalization cost of $77,446. There was a significant increase in the severe sepsis prevalence rate from 6.2% to 7.7% from 2004 to 2012 (p < 0.001) and a significant decrease in mortality from 18.9% to 12.0% (p < 0.001). Center mortality was negatively correlated with prevalence (rs = -0.48) and volume (rs = -0.39) and positively correlated with cost (rs = 0.36).

CONCLUSIONS

In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes.

Authors+Show Affiliations

1Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA. 2Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA. 4Children's Hospital Association, Kansas City, MO.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25226500

Citation

Ruth, Amanda, et al. "Pediatric Severe Sepsis: Current Trends and Outcomes From the Pediatric Health Information Systems Database." 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. 15, no. 9, 2014, pp. 828-38.
Ruth A, McCracken CE, Fortenberry JD, et al. Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatr Crit Care Med. 2014;15(9):828-38.
Ruth, A., McCracken, C. E., Fortenberry, J. D., Hall, M., Simon, H. K., & Hebbar, K. B. (2014). Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 15(9), 828-38. https://doi.org/10.1097/PCC.0000000000000254
Ruth A, et al. Pediatric Severe Sepsis: Current Trends and Outcomes From the Pediatric Health Information Systems Database. Pediatr Crit Care Med. 2014;15(9):828-38. PubMed PMID: 25226500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. AU - Ruth,Amanda, AU - McCracken,Courtney E, AU - Fortenberry,James D, AU - Hall,Matthew, AU - Simon,Harold K, AU - Hebbar,Kiran B, PY - 2014/9/17/entrez PY - 2014/9/17/pubmed PY - 2015/7/15/medline SP - 828 EP - 38 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 - 15 IS - 9 N2 - OBJECTIVE: To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization. DESIGN: Retrospective review of a prospectively collected multi-institutional children's hospital database. SETTING: PICUs in 43 U.S. children's hospitals. PATIENTS: PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data from the Pediatric Health Information System database collected by the Children's Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8-36 d) and PICU length of stay of 7 days (interquartile range, 2-17 d), with median cost/day of $4,516 and median total hospitalization cost of $77,446. There was a significant increase in the severe sepsis prevalence rate from 6.2% to 7.7% from 2004 to 2012 (p < 0.001) and a significant decrease in mortality from 18.9% to 12.0% (p < 0.001). Center mortality was negatively correlated with prevalence (rs = -0.48) and volume (rs = -0.39) and positively correlated with cost (rs = 0.36). CONCLUSIONS: In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/25226500/Pediatric_severe_sepsis:_current_trends_and_outcomes_from_the_Pediatric_Health_Information_Systems_database_ L2 - https://doi.org/10.1097/PCC.0000000000000254 DB - PRIME DP - Unbound Medicine ER -