Association Between Sepsis Recognition Compliance and Pediatric Sepsis Outcomes in the PICU

Monday, February 24, 2025

1:30pm – 2:30pm Eastern Time

Location: Connections Central Theater 1

Elizabeth Mack, MD, MS, FCCM (she/her/hers)

Medical University of South Carolina

Disclosure(s): Vizient: Employee (any industry) (Ongoing)
RB

Richard Brilli, MD, FAAP, MCCM

Physician
Nationwide Children's Hospital At Ohio State University

Disclosure information not submitted.
DC

Deborah Campbell, RN, MSN, CPHQ, T-CHEST, CCRN alumna

VP of Clinical Strategy and Transformation
Kentucky Hospital Association

Disclosure information not submitted.
JF

Julie C. Fitzgerald, MD, PhD, MSCE

Division of Critical Care Medicine, Department of Anesthesia and Critical Care
Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
Sarah Kandil, MD (she/her/hers)

Yale School of Medicine
Yale School of Medicine

Disclosure information not submitted.
GL

Gitte Larsen, MD, MPH

Pediatric Critical Care physician, Patient Safety Officer
Primary Children's Hospital

Disclosure information not submitted.
MN

Matthew Niedner, MD

Pediatric intensivist
University of Michigan

Disclosure information not submitted.
GP

Gregory Priebe, MD

Senior Associate in Critical Care, Dept. of Anesthesiology, Critical Care and Pain Medicine
Boston Children's Hospital

Disclosure information not submitted.
JW

Jennifer Workman, MD, MS

Associate professor
University of Utah School of Medicine

Disclosure information not submitted.
EB

Elise Buckwalter, MSN, CPNP-AC

Clinical Quality Improvement Consultant
Children's Hospital Association

Disclosure information not submitted.
TR

Troy Richardson, PhD

Biostatistician
Children's Hospital Association

Disclosure information not submitted.
RR

Ruth Riggs, N/A

Analyst, quality programs
Children's Hospital Association

Disclosure information not submitted.
IZ

Isabella Zaniletti, PhD

Biostatistician Consultant
Children's Hospital Association

Disclosure information not submitted.
PS

Peter Silver, MBA, MD

Chief Quality Officer, Northwell Health
Cohen Children's Medical Center

Disclosure information not submitted.

Disclosure(s):

Elizabeth Mack, MD, MS, FCCM: Vizient: Employee (any industry) (Ongoing)

Introduction: Sepsis is a leading cause of pediatric intensive care unit (PICU) death. Guidelines recommend prompt sepsis recognition which may lead to more timely care delivery and improved outcomes. Using data from the Improving Pediatric Sepsis Outcomes (IPSO) Collaborative, we evaluated the association between PICU sepsis recognition compliance (defined as a positive sepsis screen or huddle, or use of a sepsis order set) and outcomes as well as clinical characteristic differences between early onset sepsis (EO; within 12 hours of hospital arrival), and hospital onset sepsis (HO; greater than 12 hours of hospital arrival).

Methods: This retrospective cohort study included IPSO critical sepsis (ICS) cases identified using treatment-based criteria including receipt of a vasoactive medication or a third fluid bolus with onset of sepsis in the PICU from January 2017 to December 2023. We summarized demographics and clinical characteristics using descriptive statistics and compared outcomes using Pearson Chi-square and Wilcoxon rank sum tests.

Results: The cohort included 4,649 ICS cases, 1,522 (32.7%) EO and 3,127 (67.3%) HO. Compliance with recognition was associated with lower 30-day sepsis-attributable mortality in HO sepsis (7.8% v. 10.3%, p=0.042), but not in EO sepsis (5.9% v. 5.8%, p=0.942). Further, recognition was associated with more ICU-free days (14 [0-22] v.10 [0-21], p< 0.001) and ventilator-free days (18 [0-26] v. 14 [0-25], p=0.004) per sepsis episode in HO sepsis, but not in EO sepsis. However, recognition was lower in HO sepsis than EO sepsis (26.8% v. 36.7%, p< 0.001). Patients with HO sepsis were more likely to have high-risk conditions including indwelling central line, immunocompromised status, and technology-dependence (34.3% v. 22.9%, p< 0.001).

Conclusions: Recognition was associated with reduced sepsis-attributable mortality in HO sepsis in the PICU. Recognition for HO sepsis was lower than EO sepsis, possibly due to the greater proportion of high-risk conditions among patients with HO sepsis. Strategies to support successful integration of appropriate recognition tools into PICU workflows are needed to improve early recognition and outcomes for HO PICU sepsis.