Characteristics of Sepsis Events and Hospitalization in Children and Young Adults, by Age Group
| Characteristic . | Age Group . | ||||
|---|---|---|---|---|---|
| Total (N = 736) . | 30 Days–11 Months (n = 90) . | 1–4 Years (n = 145) . | 5–12 Years (n = 219) . | 13–21 Years (n = 282) . | |
| Patient location at the time the sepsis diagnosis was first documented in the medical record | |||||
| ICU | 324 (44.0) | 48 (53.3) | 79 (54.5) | 94 (42.9) | 103 (36.5) |
| Emergency department | 295 (40.1) | 28 (31.1) | 46 (31.7) | 91 (41.6) | 130 (46.1) |
| Inpatient ward | 104 (14.1) | 12 (13.3) | 19 (13.1) | 32 (14.6) | 41 (14.5) |
| Other | 2 (0.3) | 0 | 0 | 1 (0.5) | 1 (0.4) |
| Unknown | 11 (1.5) | 2 (2.2) | 1 (0.7) | 1 (0.5) | 7 (2.5) |
| Days from admission to sepsis diagnosis, median (IQR)a | 0 (0–1) | 0 (0–2) | 0 (0–1) | 0 (0–1) | 0 (0–1) |
| Epidemiologic classification of sepsis episode | |||||
| Community onset | 613 (83.3) | 65 (72.2) | 112 (77.2) | 182 (83.1) | 238 (84.4) |
| Community associated | 254 (34.5) | 28 (31.1) | 38 (26.2) | 71 (32.4) | 117 (41.5) |
| Healthcare associated | 344 (46.7) | 37 (41.1) | 74 (51.0) | 111 (50.7) | 122 (43.3) |
| Unknown healthcare association | 15 (2.0) | 4 (4.4) | 1 (0.7) | 7 (3.2) | 3 (1.1) |
| Hospital onset | 106 (14.4) | 18 (20.0) | 28 (19.3) | 25 (11.4) | 35 (12.4) |
| Unknown onset | 17 (2.3) | 3 (3.3) | 4 (2.8) | 5 (2.3) | 5 (1.8) |
| Admitted to the ICU during the sepsis hospitalization | 647 (87.9) | 80 (88.9) | 129 (89.0) | 197 (90.0) | 241 (85.5) |
| Days in ICU, median (IQR)b | 4 (2–11) | 6 (3–14) | 7 (2–15) | 4 (2–9) | 3 (2–8) |
| Indicators of organ dysfunctionc | |||||
| Any indicator of organ dysfunction | 682 (92.7) | 86 (95.6) | 135 (93.1) | 204 (93.2) | 257 (91.1) |
| Systolic blood pressure <90 mm Hg | 516 (70.1) | 55 (61.1) | 103 (71.0) | 165 (75.3) | 193 (68.4) |
| Vasopressors | 370 (50.3) | 37 (41.1) | 64 (44.1) | 119 (54.3) | 150 (53.2) |
| Lactate ≥2 mmol/L | 345 (46.9) | 40 (44.4) | 68 (46.9) | 109 (49.8) | 128 (45.4) |
| Platelets <100 000/µL | 287 (39.0) | 27 (30.0) | 69 (47.6) | 86 (39.2) | 105 (37.2) |
| Invasive mechanical ventilation | 273 (37.1) | 59 (65.6) | 66 (45.5) | 78 (35.6) | 70 (24.8) |
| Creatinine ≥2 times baseline | 252 (34.2) | 33 (36.7) | 52 (35.9) | 66 (30.1) | 101 (35.8) |
| Altered mental status | 175 (23.8) | 29 (32.2) | 35 (24.1) | 57 (26.0) | 54 (19.1) |
| Noninvasive positive pressure ventilation | 104 (14.1) | 12 (13.3) | 20 (13.8) | 32 (14.6) | 40 (14.2) |
| Total bilirubin ≥2 times baseline and ≥2 mg/dL | 72 (9.8) | 7 (7.8) | 12 (8.3) | 14 (6.4) | 39 (13.8) |
| SIRSd | 727 (98.8) | 88 (97.8) | 144 (99.3) | 217 (99.1) | 278 (98.6) |
| Days in hospital, median (IQR)e | 10 (5–22) | 12 (5–29) | 14 (7–30) | 10 (6–20) | 7 (4–17) |
| Sepsis listed in the discharge summaryf | 483 (65.6) | 54 (60.0) | 76 (52.4) | 153 (69.9) | 200 (70.9) |
| Location to which patient was discharged from the hospital | |||||
| Private residence | 587 (79.8) | 65 (72.2) | 112 (77.2) | 185 (84.5) | 225 (79.8) |
| Deceased | 74 (10.1) | 14 (15.6) | 16 (11.0) | 17 (7.8) | 27 (9.6) |
| Another acute care hospital | 33 (4.5) | 8 (8.9) | 10 (6.9) | 5 (2.3) | 10 (3.5) |
| Long-term acute care hospital or long-term care facility | 21 (2.9) | 1 (1.1) | 2 (1.4) | 7 (3.2) | 11 (3.9) |
| Other or unknown | 21 (2.9) | 2 (2.2) | 5 (3.4) | 5 (2.3) | 9 (3.2) |
| Died within 90 d of sepsis diagnosis | 84 (11.4) | 17 (18.9) | 18 (12.4) | 17 (7.8) | 32 (11.3) |
| Characteristic . | Age Group . | ||||
|---|---|---|---|---|---|
| Total (N = 736) . | 30 Days–11 Months (n = 90) . | 1–4 Years (n = 145) . | 5–12 Years (n = 219) . | 13–21 Years (n = 282) . | |
| Patient location at the time the sepsis diagnosis was first documented in the medical record | |||||
| ICU | 324 (44.0) | 48 (53.3) | 79 (54.5) | 94 (42.9) | 103 (36.5) |
| Emergency department | 295 (40.1) | 28 (31.1) | 46 (31.7) | 91 (41.6) | 130 (46.1) |
| Inpatient ward | 104 (14.1) | 12 (13.3) | 19 (13.1) | 32 (14.6) | 41 (14.5) |
| Other | 2 (0.3) | 0 | 0 | 1 (0.5) | 1 (0.4) |
| Unknown | 11 (1.5) | 2 (2.2) | 1 (0.7) | 1 (0.5) | 7 (2.5) |
| Days from admission to sepsis diagnosis, median (IQR)a | 0 (0–1) | 0 (0–2) | 0 (0–1) | 0 (0–1) | 0 (0–1) |
| Epidemiologic classification of sepsis episode | |||||
| Community onset | 613 (83.3) | 65 (72.2) | 112 (77.2) | 182 (83.1) | 238 (84.4) |
| Community associated | 254 (34.5) | 28 (31.1) | 38 (26.2) | 71 (32.4) | 117 (41.5) |
| Healthcare associated | 344 (46.7) | 37 (41.1) | 74 (51.0) | 111 (50.7) | 122 (43.3) |
| Unknown healthcare association | 15 (2.0) | 4 (4.4) | 1 (0.7) | 7 (3.2) | 3 (1.1) |
| Hospital onset | 106 (14.4) | 18 (20.0) | 28 (19.3) | 25 (11.4) | 35 (12.4) |
| Unknown onset | 17 (2.3) | 3 (3.3) | 4 (2.8) | 5 (2.3) | 5 (1.8) |
| Admitted to the ICU during the sepsis hospitalization | 647 (87.9) | 80 (88.9) | 129 (89.0) | 197 (90.0) | 241 (85.5) |
| Days in ICU, median (IQR)b | 4 (2–11) | 6 (3–14) | 7 (2–15) | 4 (2–9) | 3 (2–8) |
| Indicators of organ dysfunctionc | |||||
| Any indicator of organ dysfunction | 682 (92.7) | 86 (95.6) | 135 (93.1) | 204 (93.2) | 257 (91.1) |
| Systolic blood pressure <90 mm Hg | 516 (70.1) | 55 (61.1) | 103 (71.0) | 165 (75.3) | 193 (68.4) |
| Vasopressors | 370 (50.3) | 37 (41.1) | 64 (44.1) | 119 (54.3) | 150 (53.2) |
| Lactate ≥2 mmol/L | 345 (46.9) | 40 (44.4) | 68 (46.9) | 109 (49.8) | 128 (45.4) |
| Platelets <100 000/µL | 287 (39.0) | 27 (30.0) | 69 (47.6) | 86 (39.2) | 105 (37.2) |
| Invasive mechanical ventilation | 273 (37.1) | 59 (65.6) | 66 (45.5) | 78 (35.6) | 70 (24.8) |
| Creatinine ≥2 times baseline | 252 (34.2) | 33 (36.7) | 52 (35.9) | 66 (30.1) | 101 (35.8) |
| Altered mental status | 175 (23.8) | 29 (32.2) | 35 (24.1) | 57 (26.0) | 54 (19.1) |
| Noninvasive positive pressure ventilation | 104 (14.1) | 12 (13.3) | 20 (13.8) | 32 (14.6) | 40 (14.2) |
| Total bilirubin ≥2 times baseline and ≥2 mg/dL | 72 (9.8) | 7 (7.8) | 12 (8.3) | 14 (6.4) | 39 (13.8) |
| SIRSd | 727 (98.8) | 88 (97.8) | 144 (99.3) | 217 (99.1) | 278 (98.6) |
| Days in hospital, median (IQR)e | 10 (5–22) | 12 (5–29) | 14 (7–30) | 10 (6–20) | 7 (4–17) |
| Sepsis listed in the discharge summaryf | 483 (65.6) | 54 (60.0) | 76 (52.4) | 153 (69.9) | 200 (70.9) |
| Location to which patient was discharged from the hospital | |||||
| Private residence | 587 (79.8) | 65 (72.2) | 112 (77.2) | 185 (84.5) | 225 (79.8) |
| Deceased | 74 (10.1) | 14 (15.6) | 16 (11.0) | 17 (7.8) | 27 (9.6) |
| Another acute care hospital | 33 (4.5) | 8 (8.9) | 10 (6.9) | 5 (2.3) | 10 (3.5) |
| Long-term acute care hospital or long-term care facility | 21 (2.9) | 1 (1.1) | 2 (1.4) | 7 (3.2) | 11 (3.9) |
| Other or unknown | 21 (2.9) | 2 (2.2) | 5 (3.4) | 5 (2.3) | 9 (3.2) |
| Died within 90 d of sepsis diagnosis | 84 (11.4) | 17 (18.9) | 18 (12.4) | 17 (7.8) | 32 (11.3) |
Data are presented as No. (%).
Abbreviations: ICU, intensive care unit; IQR, interquartile range; SIRS, systemic inflammatory response syndrome.
Three patients had sepsis diagnosis dates predating the day of admission; for 2 patients, the sepsis diagnosis date was the day before hospital admission. These were included in the analysis. For 1 patient the day of sepsis diagnosis was reported to be 6 days before admission. This appeared to be a data entry error and was changed to the day of hospital admission for analysis purposes.
Admission and/or discharge dates from the ICU were missing for 11 patients: 1 patient in the age group 30 days–11 months, 3 patients in the age group 1–4 years, 5 patients in the age group 5–12 years, and 2 patients in the age group 13–21 years.
During the period defined by the 7 days before and 7 days after sepsis diagnosis.
Criteria of the systemic inflammatory response syndrome (SIRS) were assessed each day during the 3-day period defined by the day before sepsis diagnosis through the day after sepsis diagnosis. SIRS was defined as described by Goldstein and colleagues [17]. Patients aged 30 days–17 years had to meet either the temperature criterion (>38.5°C or <36°C) or the age-based white blood cell count criterion, plus 1 additional age-based criterion. Adult SIRS criteria were used for patients who were 18–21 years old [18].
Hospital discharge date missing for 2 patients.
Data missing for 6 patients.
Characteristics of Sepsis Events and Hospitalization in Children and Young Adults, by Age Group
| Characteristic . | Age Group . | ||||
|---|---|---|---|---|---|
| Total (N = 736) . | 30 Days–11 Months (n = 90) . | 1–4 Years (n = 145) . | 5–12 Years (n = 219) . | 13–21 Years (n = 282) . | |
| Patient location at the time the sepsis diagnosis was first documented in the medical record | |||||
| ICU | 324 (44.0) | 48 (53.3) | 79 (54.5) | 94 (42.9) | 103 (36.5) |
| Emergency department | 295 (40.1) | 28 (31.1) | 46 (31.7) | 91 (41.6) | 130 (46.1) |
| Inpatient ward | 104 (14.1) | 12 (13.3) | 19 (13.1) | 32 (14.6) | 41 (14.5) |
| Other | 2 (0.3) | 0 | 0 | 1 (0.5) | 1 (0.4) |
| Unknown | 11 (1.5) | 2 (2.2) | 1 (0.7) | 1 (0.5) | 7 (2.5) |
| Days from admission to sepsis diagnosis, median (IQR)a | 0 (0–1) | 0 (0–2) | 0 (0–1) | 0 (0–1) | 0 (0–1) |
| Epidemiologic classification of sepsis episode | |||||
| Community onset | 613 (83.3) | 65 (72.2) | 112 (77.2) | 182 (83.1) | 238 (84.4) |
| Community associated | 254 (34.5) | 28 (31.1) | 38 (26.2) | 71 (32.4) | 117 (41.5) |
| Healthcare associated | 344 (46.7) | 37 (41.1) | 74 (51.0) | 111 (50.7) | 122 (43.3) |
| Unknown healthcare association | 15 (2.0) | 4 (4.4) | 1 (0.7) | 7 (3.2) | 3 (1.1) |
| Hospital onset | 106 (14.4) | 18 (20.0) | 28 (19.3) | 25 (11.4) | 35 (12.4) |
| Unknown onset | 17 (2.3) | 3 (3.3) | 4 (2.8) | 5 (2.3) | 5 (1.8) |
| Admitted to the ICU during the sepsis hospitalization | 647 (87.9) | 80 (88.9) | 129 (89.0) | 197 (90.0) | 241 (85.5) |
| Days in ICU, median (IQR)b | 4 (2–11) | 6 (3–14) | 7 (2–15) | 4 (2–9) | 3 (2–8) |
| Indicators of organ dysfunctionc | |||||
| Any indicator of organ dysfunction | 682 (92.7) | 86 (95.6) | 135 (93.1) | 204 (93.2) | 257 (91.1) |
| Systolic blood pressure <90 mm Hg | 516 (70.1) | 55 (61.1) | 103 (71.0) | 165 (75.3) | 193 (68.4) |
| Vasopressors | 370 (50.3) | 37 (41.1) | 64 (44.1) | 119 (54.3) | 150 (53.2) |
| Lactate ≥2 mmol/L | 345 (46.9) | 40 (44.4) | 68 (46.9) | 109 (49.8) | 128 (45.4) |
| Platelets <100 000/µL | 287 (39.0) | 27 (30.0) | 69 (47.6) | 86 (39.2) | 105 (37.2) |
| Invasive mechanical ventilation | 273 (37.1) | 59 (65.6) | 66 (45.5) | 78 (35.6) | 70 (24.8) |
| Creatinine ≥2 times baseline | 252 (34.2) | 33 (36.7) | 52 (35.9) | 66 (30.1) | 101 (35.8) |
| Altered mental status | 175 (23.8) | 29 (32.2) | 35 (24.1) | 57 (26.0) | 54 (19.1) |
| Noninvasive positive pressure ventilation | 104 (14.1) | 12 (13.3) | 20 (13.8) | 32 (14.6) | 40 (14.2) |
| Total bilirubin ≥2 times baseline and ≥2 mg/dL | 72 (9.8) | 7 (7.8) | 12 (8.3) | 14 (6.4) | 39 (13.8) |
| SIRSd | 727 (98.8) | 88 (97.8) | 144 (99.3) | 217 (99.1) | 278 (98.6) |
| Days in hospital, median (IQR)e | 10 (5–22) | 12 (5–29) | 14 (7–30) | 10 (6–20) | 7 (4–17) |
| Sepsis listed in the discharge summaryf | 483 (65.6) | 54 (60.0) | 76 (52.4) | 153 (69.9) | 200 (70.9) |
| Location to which patient was discharged from the hospital | |||||
| Private residence | 587 (79.8) | 65 (72.2) | 112 (77.2) | 185 (84.5) | 225 (79.8) |
| Deceased | 74 (10.1) | 14 (15.6) | 16 (11.0) | 17 (7.8) | 27 (9.6) |
| Another acute care hospital | 33 (4.5) | 8 (8.9) | 10 (6.9) | 5 (2.3) | 10 (3.5) |
| Long-term acute care hospital or long-term care facility | 21 (2.9) | 1 (1.1) | 2 (1.4) | 7 (3.2) | 11 (3.9) |
| Other or unknown | 21 (2.9) | 2 (2.2) | 5 (3.4) | 5 (2.3) | 9 (3.2) |
| Died within 90 d of sepsis diagnosis | 84 (11.4) | 17 (18.9) | 18 (12.4) | 17 (7.8) | 32 (11.3) |
| Characteristic . | Age Group . | ||||
|---|---|---|---|---|---|
| Total (N = 736) . | 30 Days–11 Months (n = 90) . | 1–4 Years (n = 145) . | 5–12 Years (n = 219) . | 13–21 Years (n = 282) . | |
| Patient location at the time the sepsis diagnosis was first documented in the medical record | |||||
| ICU | 324 (44.0) | 48 (53.3) | 79 (54.5) | 94 (42.9) | 103 (36.5) |
| Emergency department | 295 (40.1) | 28 (31.1) | 46 (31.7) | 91 (41.6) | 130 (46.1) |
| Inpatient ward | 104 (14.1) | 12 (13.3) | 19 (13.1) | 32 (14.6) | 41 (14.5) |
| Other | 2 (0.3) | 0 | 0 | 1 (0.5) | 1 (0.4) |
| Unknown | 11 (1.5) | 2 (2.2) | 1 (0.7) | 1 (0.5) | 7 (2.5) |
| Days from admission to sepsis diagnosis, median (IQR)a | 0 (0–1) | 0 (0–2) | 0 (0–1) | 0 (0–1) | 0 (0–1) |
| Epidemiologic classification of sepsis episode | |||||
| Community onset | 613 (83.3) | 65 (72.2) | 112 (77.2) | 182 (83.1) | 238 (84.4) |
| Community associated | 254 (34.5) | 28 (31.1) | 38 (26.2) | 71 (32.4) | 117 (41.5) |
| Healthcare associated | 344 (46.7) | 37 (41.1) | 74 (51.0) | 111 (50.7) | 122 (43.3) |
| Unknown healthcare association | 15 (2.0) | 4 (4.4) | 1 (0.7) | 7 (3.2) | 3 (1.1) |
| Hospital onset | 106 (14.4) | 18 (20.0) | 28 (19.3) | 25 (11.4) | 35 (12.4) |
| Unknown onset | 17 (2.3) | 3 (3.3) | 4 (2.8) | 5 (2.3) | 5 (1.8) |
| Admitted to the ICU during the sepsis hospitalization | 647 (87.9) | 80 (88.9) | 129 (89.0) | 197 (90.0) | 241 (85.5) |
| Days in ICU, median (IQR)b | 4 (2–11) | 6 (3–14) | 7 (2–15) | 4 (2–9) | 3 (2–8) |
| Indicators of organ dysfunctionc | |||||
| Any indicator of organ dysfunction | 682 (92.7) | 86 (95.6) | 135 (93.1) | 204 (93.2) | 257 (91.1) |
| Systolic blood pressure <90 mm Hg | 516 (70.1) | 55 (61.1) | 103 (71.0) | 165 (75.3) | 193 (68.4) |
| Vasopressors | 370 (50.3) | 37 (41.1) | 64 (44.1) | 119 (54.3) | 150 (53.2) |
| Lactate ≥2 mmol/L | 345 (46.9) | 40 (44.4) | 68 (46.9) | 109 (49.8) | 128 (45.4) |
| Platelets <100 000/µL | 287 (39.0) | 27 (30.0) | 69 (47.6) | 86 (39.2) | 105 (37.2) |
| Invasive mechanical ventilation | 273 (37.1) | 59 (65.6) | 66 (45.5) | 78 (35.6) | 70 (24.8) |
| Creatinine ≥2 times baseline | 252 (34.2) | 33 (36.7) | 52 (35.9) | 66 (30.1) | 101 (35.8) |
| Altered mental status | 175 (23.8) | 29 (32.2) | 35 (24.1) | 57 (26.0) | 54 (19.1) |
| Noninvasive positive pressure ventilation | 104 (14.1) | 12 (13.3) | 20 (13.8) | 32 (14.6) | 40 (14.2) |
| Total bilirubin ≥2 times baseline and ≥2 mg/dL | 72 (9.8) | 7 (7.8) | 12 (8.3) | 14 (6.4) | 39 (13.8) |
| SIRSd | 727 (98.8) | 88 (97.8) | 144 (99.3) | 217 (99.1) | 278 (98.6) |
| Days in hospital, median (IQR)e | 10 (5–22) | 12 (5–29) | 14 (7–30) | 10 (6–20) | 7 (4–17) |
| Sepsis listed in the discharge summaryf | 483 (65.6) | 54 (60.0) | 76 (52.4) | 153 (69.9) | 200 (70.9) |
| Location to which patient was discharged from the hospital | |||||
| Private residence | 587 (79.8) | 65 (72.2) | 112 (77.2) | 185 (84.5) | 225 (79.8) |
| Deceased | 74 (10.1) | 14 (15.6) | 16 (11.0) | 17 (7.8) | 27 (9.6) |
| Another acute care hospital | 33 (4.5) | 8 (8.9) | 10 (6.9) | 5 (2.3) | 10 (3.5) |
| Long-term acute care hospital or long-term care facility | 21 (2.9) | 1 (1.1) | 2 (1.4) | 7 (3.2) | 11 (3.9) |
| Other or unknown | 21 (2.9) | 2 (2.2) | 5 (3.4) | 5 (2.3) | 9 (3.2) |
| Died within 90 d of sepsis diagnosis | 84 (11.4) | 17 (18.9) | 18 (12.4) | 17 (7.8) | 32 (11.3) |
Data are presented as No. (%).
Abbreviations: ICU, intensive care unit; IQR, interquartile range; SIRS, systemic inflammatory response syndrome.
Three patients had sepsis diagnosis dates predating the day of admission; for 2 patients, the sepsis diagnosis date was the day before hospital admission. These were included in the analysis. For 1 patient the day of sepsis diagnosis was reported to be 6 days before admission. This appeared to be a data entry error and was changed to the day of hospital admission for analysis purposes.
Admission and/or discharge dates from the ICU were missing for 11 patients: 1 patient in the age group 30 days–11 months, 3 patients in the age group 1–4 years, 5 patients in the age group 5–12 years, and 2 patients in the age group 13–21 years.
During the period defined by the 7 days before and 7 days after sepsis diagnosis.
Criteria of the systemic inflammatory response syndrome (SIRS) were assessed each day during the 3-day period defined by the day before sepsis diagnosis through the day after sepsis diagnosis. SIRS was defined as described by Goldstein and colleagues [17]. Patients aged 30 days–17 years had to meet either the temperature criterion (>38.5°C or <36°C) or the age-based white blood cell count criterion, plus 1 additional age-based criterion. Adult SIRS criteria were used for patients who were 18–21 years old [18].
Hospital discharge date missing for 2 patients.
Data missing for 6 patients.
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