Faculty Collaboration Database

Characteristics and Outcomes of Sepsis Presenting in Inpatient Pediatric Settings. Hosp Pediatr 2022 Dec 01;12(12):1048-1059

Date

11/09/2022

Pubmed ID

36345706

DOI

10.1542/hpeds.2022-006592

Scopus ID

2-s2.0-85150295686 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

OBJECTIVE: The pediatric sepsis literature lacks studies examining the inpatient setting, yet sepsis remains a leading cause of death in children's hospitals. More information is needed about sepsis arising in patients already hospitalized to improve morbidity and mortality outcomes. This study describes the clinical characteristics, process measures, and outcomes of inpatient sepsis cases compared with emergency department (ED) sepsis cases within the Improving Pediatric Sepsis Outcomes data registry from 46 hospitals that care for children.

METHODS: This retrospective cohort study included Improving Pediatric Sepsis Outcomes sepsis cases from January 2017 to December 2019 with onset in inpatient or ED. We used descriptive statistics to compare inpatient and ED sepsis metrics and describe inpatient sepsis outcomes.

RESULTS: The cohort included 26 855 cases; 8.4% were inpatient and 91.6% were ED. Inpatient cases had higher sepsis-attributable mortality (2.0% vs 1.4%, P = .025), longer length of stay after sepsis recognition (9 vs 5 days, P <.001), more intensive care admissions (57.6% vs 54.1%, P = .002), and greater average vasopressor use (18.0% vs 13.6%, P <.001) compared with ED. In the inpatient cohort, >40% of cases had a time from arrival to recognition within 12 hours. In 21% of cases, this time was >96 hours. Improved adherence to sepsis treatment bundles over time was associated with improved 30-day sepsis-attributable mortality for inpatients with sepsis.

CONCLUSIONS: Inpatient sepsis cases had longer lengths of stay, more need for intensive care, and higher vasopressor use. Sepsis-attributable mortality was significantly higher in inpatient cases compared with ED cases and improved with improved sepsis bundle adherence.

Author List

Schafer M, Gruhler De Souza H, Paul R, Riggs R, Richardson T, Conlon P, Duffy S, Foster LZ, Gunderson J, Hall D, Hatcher L, Hess LM, Kirkpatrick L, Kunar J, Lockwood J, Lowerre T, McFadden V, Raghavan A, Rizzi J, Stephen R, Stokes S, Workman JK, Kandil SB

Authors

Vanessa Mcfadden MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Nathan Thompson MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Emergency Service, Hospital
Hospital Mortality
Hospitals, Pediatric
Humans
Inpatients
Length of Stay
Retrospective Studies
Sepsis