Application of the Improving Pediatric Sepsis Outcomes Definition for Pediatric Sepsis to Nationally Representative Emergency Department Data

Abstract

Introduction: To compare encounter estimates and demographics of pediatric patients (<18 years) meeting modified Improving Pediatric Sepsis Outcomes (IPSO) criteria for sepsis to cohorts obtained using other criteria for pediatric sepsis from administrative datasets. Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 2003-2018. We report encounter estimates, demographics, and treatments among pediatric sepsis events using 3 criteria: modified IPSO criteria for sepsis, explicit criteria using diagnostic codes, and implicit severe sepsis criteria requiring the presence of infection and organ dysfunction. Results: The modified IPSO, explicit, and severe sepsis criteria estimated the yearly encounter rates as 116,200, 27,900, and 56,000 respectively. The modified IPSO sepsis criteria accounted for 0.4% of emergency department encounters, with a high proportion of patients who received antibiotics (99.2%, 95% CI 97.8%-100.0%), intravenous fluids (100.0%, 95% CI 99.9%-100.0%), and blood cultures (98.7%, 95% CI 96.9%-100.0%). The explicit cohort had lower proportions with blood cultures (60.6%, 95% CI 40.4%-80.7%) and antibiotic use (77.0%, 95% CI 63.1%-90.8%), but a high proportion admitted (84.0% 95% CI 73.4%-95.7%). The severe sepsis definition had low proportions with blood cultures (12.7%, 95% CI 6.3%-19.1%) and admission (21.1%, 95% CI 14.5%-27.8%). Conclusions: Pediatric sepsis estimates differed based on the criteria used for cohort ascertainment. The modified IPSO sepsis criteria group had higher acuity than the severe sepsis cohort but lower acuity than the cohort identified using the explicit sepsis criteria.