Characteristics and outcomes of sepsis presenting in inpatient pediatric settings


Melissa Schafer, Upstate Golisano Children's Hospital, State University of New York Upstate College of Medicine, Syracuse, New York.
Heidi Gruhler De Souza, Children's Hospital Association, Lenexa, Kansas.
Raina Paul, Advocate Aurora Health
Ruth Riggs, Children's Hospital Association, Lenexa, Kansas.
Troy Richardson, Children's Hospital Association, Lenexa, Kansas.
Patricia Conlon, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota.
Susan Duffy, Department of Emergency Medicine and Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island.
Lauren Z. Foster, Department of Pediatrics, New York University School of Medicine, New York, New York.
Julie Gunderson, Helen DeVos Children's Hospital, Department of Pediatric Hospital Medicine, Grand Rapids, Michigan.
David Hall, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota.
Laura Hatcher, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Lauren M. Hess, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Lauren Kirkpatrick, Department of Pediatrics, Division of Hospital Medicine, University of Missouri Kansas City School of Medicine and Children's Mercy Hospital, Kansas City, Missouri.
Jillian Kunar, Nationwide Children's Hospital, Columbus, Ohio.
Justin Lockwood, Department of Pediatrics, Section of Hospital Medicine, University of Colorado School of Medicine & Children's Hospital Colorado, Aurora, Colorado.
Tracy Lowerre, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
Vanessa McFadden, Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Anita Raghavan, Akron Children's Hospital, Akron, Ohio.
Jennifer Rizzi, Children's Memorial Hermann Hospital, Houston, Texas.
Rebecca Stephen, Department of Pediatrics, Division of Hospital Based Medicine, Northwestern Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Stacey Stokes, Department of Pediatric Hospital Medicine, George Washington University School of Medicine and Children's National Hospital, Washington, District of Columbia.
Jennifer K. Workman, Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine & Primary Children's Hospital, Salt Lake City, Utah; and.
Sarah B. Kandil, Section of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Yale University and Yale New Haven Children's Hospital, New Haven, Connecticut.


Advocate Children's Hospital


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.

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