Characteristics and Outcomes of Sepsis Presenting in Inpatient Pediatric Settings.

Creator(s)

Melissa Schafer
Heidi Gruhler De Souza
Raina Paul
Ruth Riggs
Troy Richardson
Patricia Conlon
Susan Duffy
Lauren Z. Foster
Julie Gunderson
David Hall
Laura Hatcher
Lauren M. Hess
Lauren Kirkpatrick, Children's Mercy Kansas CityFollow
Jillian Kunar
Justin Lockwood
Tracy Lowerre
Vanessa McFadden
Anita Raghavan
Jennifer Rizzi
Rebecca Stephen
Stacey Stokes
Jennifer K. Workman
Sarah B. Kandil

Document Type

Article

Publication Date

12-1-2022

Identifier

DOI: 10.1542/hpeds.2022-006592

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, P40% 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.

Journal Title

Hosp Pediatr

Volume

12

Issue

12

First Page

1048

Last Page

1059

MeSH Keywords

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

Keywords

Inpatients; Hospital Mortality; Retrospective Studies; Sepsis; Hospital Emergency Service; Pediatric Hospitals; Length of Stay

Recommended Citation

Schafer M, Gruhler De Souza H, Paul R, et al. Characteristics and Outcomes of Sepsis Presenting in Inpatient Pediatric Settings. Hosp Pediatr. 2022;12(12):1048-1059. doi:10.1542/hpeds.2022-006592