title: Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database.
abstract: OBJECTIVE
  To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization.
  
  
  METHODS
  Retrospective review of a prospectively collected multi-institutional children's hospital database.
  
  
  METHODS
  PICUs in 43 U.S. children's hospitals.
  
  
  METHODS
  PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data from the Pediatric Health Information System database collected by the Children's Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8-36 d) and PICU length of stay of 7 days (interquartile range, 2-17 d), with median cost/day of $4,516 and median total hospitalization cost of $77,446. There was a significant increase in the severe sepsis prevalence rate from 6.2% to 7.7% from 2004 to 2012 (p < 0.001) and a significant decrease in mortality from 18.9% to 12.0% (p < 0.001). Center mortality was negatively correlated with prevalence (rs = -0.48) and volume (rs = -0.39) and positively correlated with cost (rs = 0.36).
  
  
  CONCLUSIONS
  In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes.
authors.affiliation: 1Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA. 2Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA. 4Children's Hospital Association, Kansas City, MO.
authors.forename: Amanda
authors.initials: A
authors.lastname: Ruth
authors.forename: Courtney E
authors.initials: CE
authors.lastname: McCracken
authors.forename: James D
authors.initials: JD
authors.lastname: Fortenberry
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.forename: Kiran B
authors.initials: KB
authors.lastname: Hebbar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D063305:Organ Dysfunction Scores; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology