Ruth Amanda, McCracken Courtney E, Fortenberry James D, Hall Matthew, Simon Harold K, Hebbar Kiran B
1Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA. 2Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA. 4Children's Hospital Association, Kansas City, MO.
Pediatr Crit Care Med. 2014 Nov;15(9):828-38. doi: 10.1097/PCC.0000000000000254.
To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization.
Retrospective review of a prospectively collected multi-institutional children's hospital database.
PICUs in 43 U.S. children's hospitals.
PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock.
None.
Data from the Pediatric Health Information System database collected by the Children's Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8-36 d) and PICU length of stay of 7 days (interquartile range, 2-17 d), with median cost/day of $4,516 and median total hospitalization cost of $77,446. There was a significant increase in the severe sepsis prevalence rate from 6.2% to 7.7% from 2004 to 2012 (p < 0.001) and a significant decrease in mortality from 18.9% to 12.0% (p < 0.001). Center mortality was negatively correlated with prevalence (rs = -0.48) and volume (rs = -0.39) and positively correlated with cost (rs = 0.36).
In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes.
1）描述美国专科医院中患有严重脓毒症的儿科重症监护病房（PICU）患者的特征及随时间变化的结果；2）确定儿科严重脓毒症死亡风险的患者亚组；3）描述儿科严重脓毒症的总体资源利用情况。
对前瞻性收集的多机构儿童医院数据库进行回顾性分析。
美国43家儿童医院的PICU。
根据改良的安格斯标准和国际疾病分类第九版（ICD-9）中严重脓毒症和感染性休克的编码，确定出生至19岁以下的PICU患者患有严重脓毒症。
无。
来自儿童医院协会2004年至2012年收集的儿科健康信息系统数据库的数据。儿科严重脓毒症的定义为：1）ICD-9中反映严重脓毒症和感染性休克的编码；2）根据改良安格斯标准定义的感染和器官功能障碍的ICD-9编码。2004年至2012年，从43家医院中识别出636,842名患者。儿科严重脓毒症患病率为7.7%（49,153例），相关死亡率为14.4%。年龄小于1岁（与10至<19岁相比）（优势比，1.4）、潜在心血管疾病（优势比，1.4）和多器官功能障碍，死亡几率更高。资源负担较重，住院时间中位数为17天（四分位间距，8 - 36天），PICU住院时间中位数为7天（四分位间距，2 - 17天），每日费用中位数为4,516美元，住院总费用中位数为77,446美元。2004年至2012年，严重脓毒症患病率从6.2%显著增加至7.7%（p < 0.001），死亡率从18.9%显著降至12.0%（p < 0.001）。中心死亡率与患病率（rs = -0.48）和病例数（rs = -0.39）呈负相关，与费用（rs = 0.36）呈正相关。
在这个迄今为止报告的最大的儿科严重脓毒症队列中，2004年至2012年患病率增加而相关死亡率下降。年龄、心血管合并症和器官功能障碍是重要的预后因素。儿科严重脓毒症仍然是PICU收治和死亡的重要原因，并导致大量医疗费用负担。单个中心的患病率和病例数与改善的结果相关。
