Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study

Abstract

Rationale: Limited data exist about the international burden of severe sepsis in critically ill children.

Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials.

Methods: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator- and vasoactive-free days at Day 28, functional status, and mortality.

Measurements and main results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resource-limited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR, 12-28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,471 [corrected] patients per group.

Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.

Keywords: multiple organ failure; pediatrics; sepsis.

Figure 1.

Schematic depicting screening and patient enrollment. For sites with incomplete screening or patient data, all data from that site on the study day were excluded from the analysis (total of 126 patients from four sites). A waiver of consent was approved at all sites for screening and at all but three sites for data collection.

Figure 2.

Pediatric intensive care unit (PICU) mortality by age and presence of at least one comorbid condition. Bars represent PICU mortality, with error bars denoting the 95% confidence interval. PICU mortality did not differ significantly across age categories (P = 0.42) or by presence of comorbid conditions (P = 0.35).