Tags

Type your tag names separated by a space and hit enter

Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study.
Pediatr Crit Care Med. 2019 03; 20(3):e122-e129.PC

Abstract

OBJECTIVES

To evaluate the proportion of children fulfilling "Sepsis-3" definition and International Pediatric Sepsis Consensus Conference definition among children diagnosed to have septic shock and compare the mortality risk between the two groups.

DESIGN

Retrospective chart review.

SETTING

PICU of a tertiary care teaching hospital from 2014 to 2017.

PATIENTS

Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We applied both International Pediatric Sepsis Consensus Conference and the new "Sepsis-3" definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling "Sepsis-3" definitions ("Sepsis-3" group) and those fulfilling "International Pediatric Sepsis Consensus Conference" definition ("International Pediatric Sepsis Consensus Conference" group). A total of 216 patients fulfilled International Pediatric Sepsis Consensus Conference definitions of septic shock. Of these, only 104 (48%; 95% CI, 42-55) fulfilled "Sepsis-3" definition. Children fulfilling "Sepsis-3 plus International Pediatric Sepsis Consensus Conference definitions" ("Sepsis-3 and International Pediatric Sepsis Consensus Conference" group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62-0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07-1.45) at 24 hours. The mortality was 48.5% in "Sepsis-3 and International Pediatric Sepsis Consensus Conference" group as compared with 37.5% in the "International Pediatric Sepsis Consensus Conference only" group (relative risk, 1.3; 95% CI, 0.94-1.75).

CONCLUSIONS

Less than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per "Sepsis-3" definitions. Lack of difference in the risk of mortality between children who fulfilled "Sepsis-3" definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children.

Authors+Show Affiliations

All authors: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30640887

Citation

Sankar, Jhuma, et al. "Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: a Retrospective Study." 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. 20, no. 3, 2019, pp. e122-e129.
Sankar J, Dhochak N, Kumar K, et al. Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study. Pediatr Crit Care Med. 2019;20(3):e122-e129.
Sankar, J., Dhochak, N., Kumar, K., Singh, M., Sankar, M. J., & Lodha, R. (2019). Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 20(3), e122-e129. https://doi.org/10.1097/PCC.0000000000001864
Sankar J, et al. Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: a Retrospective Study. Pediatr Crit Care Med. 2019;20(3):e122-e129. PubMed PMID: 30640887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study. AU - Sankar,Jhuma, AU - Dhochak,Nitin, AU - Kumar,Kiran, AU - Singh,Man, AU - Sankar,M Jeeva, AU - Lodha,Rakesh, PY - 2019/1/15/pubmed PY - 2020/5/6/medline PY - 2019/1/15/entrez SP - e122 EP - e129 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 - 20 IS - 3 N2 - OBJECTIVES: To evaluate the proportion of children fulfilling "Sepsis-3" definition and International Pediatric Sepsis Consensus Conference definition among children diagnosed to have septic shock and compare the mortality risk between the two groups. DESIGN: Retrospective chart review. SETTING: PICU of a tertiary care teaching hospital from 2014 to 2017. PATIENTS: Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We applied both International Pediatric Sepsis Consensus Conference and the new "Sepsis-3" definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling "Sepsis-3" definitions ("Sepsis-3" group) and those fulfilling "International Pediatric Sepsis Consensus Conference" definition ("International Pediatric Sepsis Consensus Conference" group). A total of 216 patients fulfilled International Pediatric Sepsis Consensus Conference definitions of septic shock. Of these, only 104 (48%; 95% CI, 42-55) fulfilled "Sepsis-3" definition. Children fulfilling "Sepsis-3 plus International Pediatric Sepsis Consensus Conference definitions" ("Sepsis-3 and International Pediatric Sepsis Consensus Conference" group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62-0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07-1.45) at 24 hours. The mortality was 48.5% in "Sepsis-3 and International Pediatric Sepsis Consensus Conference" group as compared with 37.5% in the "International Pediatric Sepsis Consensus Conference only" group (relative risk, 1.3; 95% CI, 0.94-1.75). CONCLUSIONS: Less than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per "Sepsis-3" definitions. Lack of difference in the risk of mortality between children who fulfilled "Sepsis-3" definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/30640887/Comparison_of_International_Pediatric_Sepsis_Consensus_Conference_Versus_Sepsis_3_Definitions_for_Children_Presenting_With_Septic_Shock_to_a_Tertiary_Care_Center_in_India:_A_Retrospective_Study_ L2 - https://doi.org/10.1097/PCC.0000000000001864 DB - PRIME DP - Unbound Medicine ER -