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Health-Related Quality of Life Among Survivors of Pediatric Sepsis.
Pediatr Crit Care Med. 2019 06; 20(6):501-509.PC

Abstract

OBJECTIVES

Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis.

DESIGN

Retrospective cohort study.

SETTING

Seattle Children's Hospital.

PATIENTS

Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We assessed health-related quality of life with the Pediatric Quality of Life Inventory for pre-admission baseline, admission, and post-discharge (median, 31 d) status. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline at follow-up (the minimum clinically significant difference between two scores). Of 790 patients, 23.8% failed to recover to baseline health-related quality of life at follow-up. Factors associated with failure to recover were septic shock, older age, private insurance, complex chronic disease, immune compromise, CNS infection or bacteremia, ICU admission, and longer length of stay. On multivariable analysis controlling for time to follow-up, failure to recover was independently associated with septic shock (relative risk, 1.79; 95% CI, 1.24-2.58), older age (relative risk, 1.02/yr; 95% CI, 1.01-1.05), immune compromise (relative risk, 1.83; 95% CI, 1.40-2.40), and length of stay (relative risk, 1.03/d; 95% CI, 1.01-1.04).

CONCLUSIONS

Nearly one-quarter of children surviving hospitalization for community-acquired sepsis experienced a clinically significant deterioration in health-related quality of life. We identify risk factors for poor outcomes following sepsis and highlight the need for ongoing evaluation and treatment by primary and specialty care providers for pediatric sepsis survivors after hospital discharge.

Authors+Show Affiliations

Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA. Harborview Injury Prevention & Research Center, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA. Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA. Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA. Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA. Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30720672

Citation

Killien, Elizabeth Y., et al. "Health-Related Quality of Life Among Survivors of Pediatric Sepsis." 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. 6, 2019, pp. 501-509.
Killien EY, Farris RWD, Watson RS, et al. Health-Related Quality of Life Among Survivors of Pediatric Sepsis. Pediatr Crit Care Med. 2019;20(6):501-509.
Killien, E. Y., Farris, R. W. D., Watson, R. S., Dervan, L. A., & Zimmerman, J. J. (2019). Health-Related Quality of Life Among Survivors of Pediatric Sepsis. 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(6), 501-509. https://doi.org/10.1097/PCC.0000000000001886
Killien EY, et al. Health-Related Quality of Life Among Survivors of Pediatric Sepsis. Pediatr Crit Care Med. 2019;20(6):501-509. PubMed PMID: 30720672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health-Related Quality of Life Among Survivors of Pediatric Sepsis. AU - Killien,Elizabeth Y, AU - Farris,Reid W D, AU - Watson,R Scott, AU - Dervan,Leslie A, AU - Zimmerman,Jerry J, PY - 2019/2/6/pubmed PY - 2020/7/7/medline PY - 2019/2/6/entrez SP - 501 EP - 509 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 - 6 N2 - OBJECTIVES: Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis. DESIGN: Retrospective cohort study. SETTING: Seattle Children's Hospital. PATIENTS: Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We assessed health-related quality of life with the Pediatric Quality of Life Inventory for pre-admission baseline, admission, and post-discharge (median, 31 d) status. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline at follow-up (the minimum clinically significant difference between two scores). Of 790 patients, 23.8% failed to recover to baseline health-related quality of life at follow-up. Factors associated with failure to recover were septic shock, older age, private insurance, complex chronic disease, immune compromise, CNS infection or bacteremia, ICU admission, and longer length of stay. On multivariable analysis controlling for time to follow-up, failure to recover was independently associated with septic shock (relative risk, 1.79; 95% CI, 1.24-2.58), older age (relative risk, 1.02/yr; 95% CI, 1.01-1.05), immune compromise (relative risk, 1.83; 95% CI, 1.40-2.40), and length of stay (relative risk, 1.03/d; 95% CI, 1.01-1.04). CONCLUSIONS: Nearly one-quarter of children surviving hospitalization for community-acquired sepsis experienced a clinically significant deterioration in health-related quality of life. We identify risk factors for poor outcomes following sepsis and highlight the need for ongoing evaluation and treatment by primary and specialty care providers for pediatric sepsis survivors after hospital discharge. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/30720672/Health_Related_Quality_of_Life_Among_Survivors_of_Pediatric_Sepsis_ L2 - https://doi.org/10.1097/PCC.0000000000001886 DB - PRIME DP - Unbound Medicine ER -