Septic shock in children in an urban area in Western Germany--outcome, risk factors for mortality and infection epidemiology.
BACKGROUND
Only sparse data exist about children with septic shock in Europe. The present study aimed to evaluate demographics, treatment, outcome and risk factors for mortality in Western Germany.


METHODS
Children with septic shock aged 2 months to 17 years.


METHODS
In a multi-center retrospective study of 20 children's hospitals data were obtained and analyzed by chart review. Risk factors for mortality were identified and assessed by multivariate regression analysis.


RESULTS
Overall mortality in 83 cases with septic shock was 25% (21 patients). Significant risk factors were high PRISM III score, low pH, low arterial systolic blood pressure, presence of disseminated intravascular coagulation and extent of multi-organ failure, but not lactate (p=0.05) and base excess (p=0.065). Mortality in hospitals which treated 10 or more patients (category 1) was 17% and increased to 22% in hospitals which treated 3-6 patients (category 2). In hospitals with only 1 or 2 patients (category 3) mortality rate was 61% (p<0.01 when compared to category 1 or 2). A stepwise increase was also seen in the severely sick patients according to PRISM III (>19): category 1: 23%, category 2: 40%, category 3: 62.5% (p<0.05 for comparison of category 1 and 3). Multivariate analysis of significant risk factors revealed low number of treated patients as the only individual risk factor for mortality.


CONCLUSIONS
Mortality from pediatric septic shock in an urban area in Western Germany is high. Disease severity and treatment in a department with few cases were associated with increased mortality.
Pediatrics I, University of Duisburg-Essen, Essen, Germany.
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Breuling
Pediatrics I, University of Duisburg-Essen, Essen, Germany.
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Tschiedel
Pediatrics I, University of Duisburg-Essen, Essen, Germany.
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Große-Lordemann
Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Cologne, Cologne, Germany.
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Hünseler
Department of Pediatrics, St. Vincenz Hospital, Dinslaken, Germany.
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Schmidt
Department of Pediatrics, Bergmannsheil und Kinderklinik GmbH, Gelsenkirchen, Germany.
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Niemann
Department of Pediatrics, St.-Agnes-Hospital, Bocholt, Germany.
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Dettmer
Department of Pediatrics, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany.
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Freymann
Department of Pediatrics, Evangelisches Krankenhaus, Oberhausen, Germany.
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von Noorden
Department of Pediatrics, Bethanien Krankenhaus, Moers, Germany.
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Wallot
Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany.
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Heister
Department of Pediatrics, Community Hospital Dortmund, Dortmund, Germany.
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Heitmann
Department of Pediatrics, St. Josephs Hospital, University of Bochum, Bochum, Germany.
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Rothoeft
Department of Neonatology and Pediatric Intensive Care Medicine, University Hospital Witten/Herdecke, Datteln, Germany.
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Schürmann
Department of Neonatology, Elisabeth-Krankenhaus, Essen, Germany.
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Backendorf
Department of Pediatrics, Helios Klinikum, Wuppertal, Germany.
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Heldmann
Department of Pediatrics, Klinikum Niederberg, Velbert, Germany.
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Schubert
Department of Pediatrics, Klinikum Duisburg, Duisburg, Germany.
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Nuńez
Department of Pediatrics, Helios Klinikum, Duisburg, Germany.
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Seiffert
Pediatrics I, University of Duisburg-Essen, Essen, Germany.
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Felderhoff-Müser
Pediatrics I, University of Duisburg-Essen, Essen, Germany.
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Dohna-Schwake
D000293:Adolescent; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D009894:Opportunistic Infections / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data*; D014777:Virus Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy