Watson R Scott, Carcillo Joseph A, Linde-Zwirble Walter T, Clermont Gilles, Lidicker Jeffrey, Angus Derek C
Department of Critical Care Medicine, Center for Research on Health Care, and the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
Am J Respir Crit Care Med. 2003 Mar 1;167(5):695-701. doi: 10.1164/rccm.200207-682OC. Epub 2002 Nov 14.
Despite extensive research into the etiology and treatment of severe sepsis, little is known about its epidemiology in children. We sought to determine the age- and sex-adjusted incidence, outcome, and associated hospital costs of severe sepsis in United States children using 1995 hospital discharge and population data from seven states (24% of the United States population). Of 1,586,253 hospitalizations in children who were 19 years old or less, 9,675 met International Classification of Diseases, 9th revision, clinical modification-based severe sepsis criteria or 42,364 cases of pediatric severe sepsis per year nationally (0.56 cases per 1,000 population per year). The incidence was the highest in infants (5.16 per 1,000), fell dramatically in older children (0.20 per 1,000 in 10 to 14 year olds), and was 15% higher in boys than in girls (0.60 versus 0.52 per 1,000, p < 0.001). Hospital mortality was 10.3%, or 4,383 deaths nationally (6.2 per 100,000 population). Half of the cases had underlying disease (49.0%), and over one-fifth (22.9%) were low-birth-weight newborns. Respiratory infections (37%) and primary bacteremia (25%) were the most common infections. The mean length of stay and cost were 31 days and $40,600, respectively. Estimated annual total costs were 1.97 billion US dollars nationally. Severe sepsis is a significant health problem in children and is associated with the use of extensive healthcare resources. Infants are at highest risk, especially those with a low birth weight.
尽管对严重脓毒症的病因和治疗进行了广泛研究，但对其在儿童中的流行病学情况却知之甚少。我们试图利用来自七个州（占美国人口的24%）的1995年医院出院和人口数据，确定美国儿童严重脓毒症经年龄和性别调整后的发病率、转归及相关住院费用。在19岁及以下儿童的1,586,253次住院病例中，有9,675例符合基于《国际疾病分类》第九版临床修订本的严重脓毒症标准，即全国每年有42,364例儿童严重脓毒症病例（每年每1000人口中有0.56例）。发病率在婴儿中最高（每1000人中有5.16例），在大龄儿童中急剧下降（10至14岁儿童中每1000人中有0.20例），男孩的发病率比女孩高15%（每1000人中有0.60例对0.52例，p<0.001）。医院死亡率为10.3%，即全国有4383例死亡（每100,000人口中有6.2例）。一半的病例有基础疾病（49.0%），超过五分之一（22.9%）是低体重新生儿。呼吸道感染（37%）和原发性菌血症（25%）是最常见的感染。平均住院时间和费用分别为31天和40,600美元。全国每年估计总费用为19.7亿美元。严重脓毒症是儿童中的一个重大健康问题，且与大量医疗资源的使用相关。婴儿风险最高，尤其是低体重婴儿。
