(1590) Understanding Healthcare Encounters in the Week Before an Admission for Sepsis in Pediatric Patients

Introduction: Despite the burden of pediatric sepsis, little is known about healthcare encounters prior to a sepsis admission. We sought to understand healthcare use in the week leading up to admissions, as this may provide opportunities for early identification, triage and treatment of children at risk for sepsis.

Methods: Index sepsis admissions were identified using IBM MarketScan and ICD-10 codes, and required insurance enrollment at least 30 days prior to admission. Patients age 0-18 years with a sepsis admission between January 1, 2016 and December 31, 2022 were included. Readmission within 30 days of index admission were excluded, as were birth-related hospitalizations. We identified outpatient encounters, emergency department (ED) visits, and inpatient hospitalizations in the 7 days before admission. Diagnoses for these encounters and characteristics of the subsequent hospitalization were collected.

Results: 6,928 admissions met inclusion criteria; 52% were female with a median age of 10 years (Interquartile Range [IQR] 3-15 years). In the 7 days before a sepsis admission, 53.5% (n=3707) of children had a healthcare encounter. 33.8% were outpatient visits, 28.2% ED visits, and 6.2% were inpatient hospitalizations with top diagnoses of fever, sepsis, and encounter for antineoplastic chemotherapy, respectively. 36.4% of encounters had an infection-related diagnosis coded. There was no difference in intensive care unit use (84.1% vs 83.2%; p=0.304), invasive mechanical ventilation (3.5% vs 3.4%; p=0.657), or length of stay (7 days [IQR 3-16], in both cohorts; p=0.06) between those who did versus did not have pre-sepsis healthcare use.

Conclusions: Half of all children admitted for sepsis have a healthcare encounter in the preceding week. They presented to the ED and outpatient setting at similar rates, and most commonly for infection-related diagnoses. However, there was no difference in subsequent inpatient hospitalization characteristics. The frequency of infection-related encounters preceding admission for sepsis suggests potential for earlier identification, treatment, and follow-up. Further research is needed to characterize admissions between both groups, which may aid in the development of tools to stratify patients at highest risk of developing sepsis.