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. 2014 Nov;15(9):798-805.
doi: 10.1097/PCC.0000000000000225.

Pediatric severe sepsis in U.S. children's hospitals

Fran Balamuth  1 , Scott L Weiss, Mark I Neuman, Halden Scott, Patrick W Brady, Raina Paul, Reid W D Farris, Richard McClead, Katie Hayes, David Gaieski, Matt Hall, Samir S Shah, Elizabeth R Alpern
Affiliations

Pediatric severe sepsis in U.S. children's hospitals

Fran Balamuth et al. Pediatr Crit Care Med. 2014 Nov.

Abstract

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.

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Figures

Figure 1
Figure 1. Sepsis prevalence
a. Number of sepsis codes in each cohort. The combination code cohort has International Classification of Diseases 9th Revision (ICD9) codes for infection plus organ dysfunction; the sepsis code cohort has ICD9 codes for severe sepsis or septic shock. b. Proportion of sepsis hospitalizations in the Pediatric Health Information Systems (PHIS) database from 2004–2011.
Figure 2
Figure 2. Resource utilization and mortality over time
a. Hospital length of stay (LOS), b. Intensive Care Unit (ICU) LOS. c. cost, and d. mortality in each cohort. ICU and Hospital LOS are calculated in days, cost is in median dollars per patient per hospitalization. Costs are presented as 2012 dollars. p<0.05 for trend for both cohorts.
Figure 3
Figure 3. Mortality in patient subsets
A is patients with combination codes not sepsis codes; B is patients with combination and sepsis codes ; C is patients with sepsis codes not combination codes. Odds Ratios (OR) are presented with accompanying 95% confidence intervals (95% CI).
See this image and copyright information in PMC

Comment in

  • Sepsis or SEPSIS: does it make a difference?
    Fontela P, Lacroix J. Fontela P, et al. Pediatr Crit Care Med. 2014 Nov;15(9):893-4. doi: 10.1097/PCC.0000000000000259. Pediatr Crit Care Med. 2014. PMID: 25370053 No abstract available.
  • Sepsis Is SEPSIS! It's High Time to Globalize Pediatric Sepsis.
    Souza DC, Barreira ER, Shieh HH, Bousso A. Souza DC, et al. Pediatr Crit Care Med. 2015 May;16(4):390-1. doi: 10.1097/PCC.0000000000000376. Pediatr Crit Care Med. 2015. PMID: 25946271 No abstract available.
  • The authors reply.
    Balamuth F, Weiss S, Neuman M, Scott H, Brady P, Farris R, McClead R, Hayes K, Paul R, Hall M, Shah S, Alpern E. Balamuth F, et al. Pediatr Crit Care Med. 2015 May;16(4):392-3. doi: 10.1097/PCC.0000000000000394. Pediatr Crit Care Med. 2015. PMID: 25946273 Free PMC article. No abstract available.

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