Clinical Fellow Boston Children's Hospital Boston Children's Hospital Department of Pediatrics Boston, Massachusetts, United States
Background: Severe sepsis and septic shock are leading causes of morbidity and mortality in the pediatric population, with over 75,000 children treated annually in the United States and mortality rates as high as 20%. Timely initiation of sepsis therapy relies on clinician recognition, which can be difficult in children due to overlap in abnormal vital signs between those with infections that will progress to life-threatening sepsis and those that will not. For other severe pediatric conditions, such as cardiac arrest, outcomes including mortality rate are better in pediatric EDs when compared to general EDs. There are no similar studies comparing outcomes in pediatric sepsis by ED type. Evaluating outcomes in pediatric sepsis by ED type would identify potential differences in care and highlight opportunities to standardize care across all EDs.
Objective:
Design/Methods: We performed a retrospective cohort study using the 2008–2017 Nationwide Emergency Department Sample. Patients <19 years with a diagnosis code of severe sepsis or septic shock were included in the sample. Pediatric EDs were defined as any hospital in the sample with >75% of all visits by pediatric patients. We compared demographic characteristics of visits to general vs pediatric EDs. We also compared pediatric EDs to general EDs on the outcome of survival to emergency department disposition or hospital visit discharge. We determined unadjusted and adjusted survival controlling for age, gender, and region.
Results: There were 54,129 weighted pediatric ED visits during the study time period with a diagnosis code of severe sepsis or septic shock. Visits to general EDs were significantly older and more likely to be female (Table 1). Of these visits, 285 patients died in the ED (0.58%) and 5,065 died during their hospital stay (9.8%) (Figure 1). Unadjusted mortality prior to ED disposition was lower in pediatric EDs than general EDs (0.31% vs 0.72%, P = .02). Unadjusted mortality prior to hospital discharge (inclusive of ED mortality) was lower in pediatric hospitals than general hospitals (7.5% vs 10.9%, P < 0.01). The adjusted odds ratio of mortality in pediatric versus general EDs was 0.3 (95% CI: 0.1-0.8) (Table 2). The adjusted odds ratio of mortality in pediatric versus general hospitals was 0.6 (95% CI: 0.5-0.8). Conclusion(s): In a nationally representative sample, pediatric mortality from severe sepsis or septic shock was higher in general EDs than pediatric EDs. Identifying the factors associated with pediatric survival from sepsis may identify areas for improvement in care.
Table 1. Demographics of Children With Sepsis in Pediatric and General EDs From the NEDS
Figure 1. Pediatric Sepsis Mortality in Pediatric and General EDs From the NEDS
Table 2. Adjusted Pediatric Sepsis Survival
Authors/Institutions: Alexandra H. Baker, Boston Children's Hospital Department of Pediatrics, Boston, Massachusetts, United States; Michael Monuteaux, Boston Children's Hospital, Boston, Massachusetts, United States; Joel Hudgins, Boston Children's Hospital, Boston, Massachusetts, United States
