Friday June 19, 2009 (pediatric pearl day)
Late death occurred with similar frequency as early death associated with initial hospitalization with severe sepsis in children


OBJECTIVE: Pediatric severe sepsis remains a significant health problem with hospital mortality up to 10%. However, there is little information about later health outcomes or needs of survivors. Therefore, our goal was to evaluate the rates of and risk factors for rehospitalization and late mortality among survivors of pediatric severe sepsis.


PATIENTS AND METHODS: This was a population-based retrospective cohort study of survivors of pediatric severe sepsis (age 1 month to 18 years) in Washington State over the years 1990–2004.


The sentinel admission was linked to subsequent death or episodes of hospitalization.
The main outcome measures were readmission and/or late death after surviving an initial hospitalization with severe sepsis.


RESULTS:

• Almost half (47%) of the survivors were readmitted at least once (median: 3) after a median of 3 months, and the majority of these readmissions were emergent.
• Sentinel admission factors independently associated with both adverse outcomes were neurologic or hematologic organ dysfunction, government-based insurance, as well as several coexisting health conditions.
• In addition, age less than 1 year at the time of sepsis and bloodstream and cardiovascular infections were highly associated with subsequent readmission.

CONCLUSIONS: Late death occurred with similar frequency as early death associated with hospitalization with severe sepsis. Almost half of the pediatric patients suffering from an episode of severe sepsis had at least 1 subsequent hospitalization, two thirds of which were emergent or urgent. These data suggest that late outcomes after an episode of severe sepsis are poor and call for the evaluation of interventions designed to reduce later morbidity and mortality.


Reference: Click to get abstract

Readmission and Late Mortality After Pediatric Severe Sepsis - Pediatrics 2009;123:849–857