This Article Full Text Full Text (PDF) All Versions of this Article: 200207-682OCv1 167/5/695    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Watson, R. S. Articles by Angus, D. C. Search for Related Content PubMed PubMed Citation Articles by Watson, R. S. Articles by Angus, D. C.

The Epidemiology of Severe Sepsis in Children in the United States

Department of Critical Care Medicine, Center for Research on Health Care, and the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, University of Pittsburgh, Pittsburgh; Health Process Management, LLC, Doylestown; and the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

Correspondence and requests for reprints should be addressed to Derek C. Angus, M.D., M.P.H., University of Pittsburgh, Department of Critical Care Medicine, CRISMA Laboratory, 604 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261. E-mail: angusdc{at}ccm.upmc.edu

Despite extensive research into the etiology and treatment of severe sepsis, little is known about its epidemiology in children. We sought to determine the age- and sex-adjusted incidence, outcome, and associated hospital costs of severe sepsis in United States children using 1995 hospital discharge and population data from seven states (24% of the United States population). Of 1,586,253 hospitalizations in children who were 19 years old or less, 9,675 met International Classification of Diseases, 9th revision, clinical modification–based severe sepsis criteria or 42,364 cases of pediatric severe sepsis per year nationally (0.56 cases per 1,000 population per year). The incidence was the highest in infants (5.16 per 1,000), fell dramatically in older children (0.20 per 1,000 in 10 to 14 year olds), and was 15% higher in boys than in girls (0.60 versus 0.52 per 1,000, p < 0.001). Hospital mortality was 10.3%, or 4,383 deaths nationally (6.2 per 100,000 population). Half of the cases had underlying disease (49.0%), and over one-fifth (22.9%) were low-birth-weight newborns. Respiratory infections (37%) and primary bacteremia (25%) were the most common infections. The mean length of stay and cost were 31 days and $40,600, respectively. Estimated annual total costs were $1.97 billion nationally. Severe sepsis is a significant health problem in children and is associated with the use of extensive healthcare resources. Infants are at highest risk, especially those with a low birth weight.

Key Words: outcome • mortality • pediatrics • intensive care

This article has been cited by other articles:

				R. S. Parker and G. Clermont Systems engineering medicine: engineering the inflammation response to infectious and traumatic challenges J R Soc Interface, February 10, 2010; (2010) rsif.2009.0517v1. [Abstract] [Full Text] [PDF]

				K. L. Henderson, A. P. Johnson, B. Muller-Pebody, A. Charlett, R. Gilbert, and M. Sharland The changing aetiology of paediatric bacteraemia in England and Wales, 1998-2007 J. Med. Microbiol., February 1, 2010; 59(2): 213 - 219. [Abstract] [Full Text] [PDF]

				K. Choong, D. Bohn, D. D. Fraser, I. Gaboury, J. S. Hutchison, A. R. Joffe, C. Litalien, K. Menon, P. McNamara, R. E. Ward, et al. Vasopressin in Pediatric Vasodilatory Shock: A Multicenter Randomized Controlled Trial Am. J. Respir. Crit. Care Med., October 1, 2009; 180(7): 632 - 639. [Abstract] [Full Text] [PDF]

				A. S. Czaja, J. J. Zimmerman, and A. B. Nathens Readmission and Late Mortality After Pediatric Severe Sepsis Pediatrics, March 1, 2009; 123(3): 849 - 857. [Abstract] [Full Text] [PDF]

				H. R. Wong, N. Cvijanovich, D. S. Wheeler, M. T. Bigham, M. Monaco, K. Odoms, W. L. Macias, and M. D. Williams Interleukin-8 as a Stratification Tool for Interventional Trials Involving Pediatric Septic Shock Am. J. Respir. Crit. Care Med., August 1, 2008; 178(3): 276 - 282. [Abstract] [Full Text] [PDF]

				K. L. Yorita, R. C. Holman, J. J. Sejvar, C. A. Steiner, and L. B. Schonberger Infectious Disease Hospitalizations Among Infants in the United States Pediatrics, February 1, 2008; 121(2): 244 - 252. [Abstract] [Full Text] [PDF]

				C. L. S. George, K. L. Goss, D. K. Meyerholz, F. S. Lamb, and J. M. Snyder Surfactant-Associated Protein A Provides Critical Immunoprotection in Neonatal Mice Infect. Immun., January 1, 2008; 76(1): 380 - 390. [Abstract] [Full Text] [PDF]

				D. M. Berkowitz and G. S. Martin Sepsis and Sex: Can We Look Beyond Our Hormones? Chest, December 1, 2007; 132(6): 1725 - 1727. [Full Text] [PDF]

				H. R. Wong, T. P. Shanley, B. Sakthivel, N. Cvijanovich, R. Lin, G. L. Allen, N. J. Thomas, A. Doctor, M. Kalyanaraman, N. M. Tofil, et al. Genome-level expression profiles in pediatric septic shock indicate a role for altered zinc homeostasis in poor outcome Physiol Genomics, July 18, 2007; 30(2): 146 - 155. [Abstract] [Full Text] [PDF]

				F. O. Odetola, A. Gebremariam, and G. L. Freed Patient and Hospital Correlates of Clinical Outcomes and Resource Utilization in Severe Pediatric Sepsis Pediatrics, March 1, 2007; 119(3): 487 - 494. [Abstract] [Full Text] [PDF]

				J. P. Cimiotti, J. Haas, L. Saiman, and E. L. Larson Impact of Staffing on Bloodstream Infections in the Neonatal Intensive Care Unit Arch Pediatr Adolesc Med, August 1, 2006; 160(8): 832 - 836. [Abstract] [Full Text] [PDF]

				A. D. Niederbichler, L. M. Hoesel, M. V. Westfall, H. Gao, K. R. Ipaktchi, L. Sun, F. S. Zetoune, G. L. Su, S. Arbabi, J. V. Sarma, et al. An essential role for complement C5a in the pathogenesis of septic cardiac dysfunction J. Exp. Med., January 23, 2006; 203(1): 53 - 61. [Abstract] [Full Text] [PDF]

				K. A. Felmet, M. W. Hall, R. S. B. Clark, R. Jaffe, and J. A. Carcillo Prolonged Lymphopenia, Lymphoid Depletion, and Hypoprolactinemia in Children with Nosocomial Sepsis and Multiple Organ Failure J. Immunol., March 15, 2005; 174(6): 3765 - 3772. [Abstract] [Full Text] [PDF]

				D. C. Stockwell and A. D. Slonim Dissecting Sepsis Outcomes in Critically Ill Children Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 297 - 298. [Full Text] [PDF]

				F. Leclerc, S. Leteurtre, A. Duhamel, B. Grandbastien, F. Proulx, A. Martinot, F. Gauvin, P. Hubert, and J. Lacroix Cumulative Influence of Organ Dysfunctions and Septic State on Mortality of Critically Ill Children Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 348 - 353. [Abstract] [Full Text] [PDF]

				J. A. Carcillo Doctors respond to capillary refill; reverse septic shock AAP News, July 1, 2004; 25(1): 18 - 18. [Full Text] [PDF]

				M. E. Kleinman Pre-Transport Management of Septic Shock AAP Grand Rounds, February 1, 2004; 11(2): 21 - 21. [Full Text] [PDF]

				M. J. Tobin Critical Care Medicine in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 239 - 253. [Full Text] [PDF]

				M. J. Tobin Pediatrics, Surfactant, and Cystic Fibrosis in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 277 - 287. [Full Text] [PDF]

				Y. Y. Han, J. A. Carcillo, M. A. Dragotta, D. M. Bills, R. S. Watson, M. E. Westerman, and R. A. Orr Early Reversal of Pediatric-Neonatal Septic Shock by Community Physicians Is Associated With Improved Outcome Pediatrics, October 1, 2003; 112(4): 793 - 799. [Abstract] [Full Text] [PDF]