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Published ahead of print on November 14, 2002, doi:10.1164/rccm.200207-682OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 5, March 2003, 695-701

A more recent version of this article appeared on March 1, 2003
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Submitted on July 10, 2002
Accepted on November 8, 2002

The epidemiology of severe sepsis in newborns, infants, and children in the U.S

R. Scott Watson1, Joseph A Carcillo1, Walter T Linde-Zwirble2, Gilles Clermont1, Jeffrey Lidicker2, and Derek C Angus1*

1 Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 2 Health Process Management, LLC, Doylestown, PA, USA

* To whom correspondence should be addressed. 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 U.S. children using 1995 hospital discharge and population data from 7 states (24% of the US population). Of 1,586,253 hospitalizations in children < 19 years old, 9,675 met ICD-9-CM based severe sepsis criteria, or 42,364 cases of pediatric severe sepsis per year nationally (0.56 cases/1000 population/year). Incidence was highest in infants (5.16/1000), fell dramatically in older children (0.20/1000 in 10 to 14 year olds), and was 15% higher in boys than in girls (0.60 vs. 0.52/1000, p<0.001). Hospital mortality was 10.3%, or 4,383 deaths nationally (6.2/100,000 population). Half of 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. Mean length of stay and cost were 31 days and $40,600. Estimated annual total costs were $1.97 billion nationally. Severe sepsis is a significant health problem in children and is associated with use of extensive healthcare resources. Infants are at highest risk, especially those of low birth weight.
Key words: outcome, mortality, pediatrics, intensive care




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