Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
Am J Emerg Med. 2022 Jan;51:53-57. doi: 10.1016/j.ajem.2021.10.007. Epub 2021 Oct 9.
Understanding differences in mortality rate secondary to sepsis between pediatric and general emergency departments (EDs) would help identify strategies to improve pediatric sepsis care. We aimed to determine if pediatric sepsis mortality differs between pediatric and general EDs.
We performed a nationally representative, retrospective cohort study using the 2008-2017 Nationwide Emergency Department Sample (NEDS) to examine visits by patients less than 19 years old with a diagnostic code of severe sepsis or septic shock. We generated national estimates of study outcomes using NEDS survey weights. We compared pediatric to general EDs on the outcomes of ED mortality and hospital mortality. We determined adjusted mortality risk using logistic regression, controlling for age, gender, complex care code, and geographic region.
There were 54,129 weighted pediatric ED visits during the study period with a diagnosis code of severe sepsis or septic shock. Of these visits, 285 died in the ED (0.58%) and 5065 died during their hospital stay (9.8%). Mortality risk prior to ED disposition in pediatric and general EDs was 0.31% and 0.72%, respectively (adjusted odds ratio (aOR), 95% confidence interval (CI): 0.36 (0.14-0.93)). Mortality risk prior to hospital discharge in pediatric and general EDs was 7.5% and 10.9%, respectively (aOR, 95% CI: 0.55 (0.41-0.72)).
In a nationally representative sample, pediatric mortality from severe sepsis or septic shock was lower in pediatric EDs than in general EDs. Identifying features of pediatric ED care associated with improved sepsis mortality could translate into improved survival for children wherever they present with sepsis.
了解儿科和普通急诊部（ED）因败血症导致的死亡率差异，有助于确定改善儿科败血症护理的策略。我们旨在确定儿科败血症死亡率是否在儿科和普通 ED 之间存在差异。
我们使用 2008-2017 年全国急诊部样本（NEDS）进行了一项全国代表性的回顾性队列研究，以检查年龄小于 19 岁的患者因严重败血症或败血症性休克而就诊的诊断代码。我们使用 NEDS 调查权重生成研究结果的全国估计值。我们比较了儿科和普通 ED 在 ED 死亡率和医院死亡率方面的结果。我们使用逻辑回归确定调整后的死亡率风险，控制年龄、性别、复杂护理代码和地理位置。
在研究期间，有 54129 例加权儿科 ED 就诊，诊断为严重败血症或败血症性休克。这些就诊中，285 人在 ED 死亡（0.58%），5065 人在住院期间死亡（9.8%）。儿科和普通 ED 就诊前的死亡率风险分别为 0.31%和 0.72%（调整后的优势比（OR），95%置信区间（CI）：0.36（0.14-0.93））。儿科和普通 ED 就诊前的住院死亡率分别为 7.5%和 10.9%（OR，95%CI：0.55（0.41-0.72））。
在一个具有全国代表性的样本中，儿科 ED 治疗严重败血症或败血症性休克的儿童死亡率低于普通 ED。确定与改善败血症死亡率相关的儿科 ED 护理特征可能会转化为提高世界各地儿童败血症患者的生存率。
