Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 849-857 (doi:10.1542/peds.2008-0856)

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ARTICLE

Readmission and Late Mortality After Pediatric Severe Sepsis

Angela S. Czaja, MD, MSc^a, Jerry J. Zimmerman, MD, PhD^b and Avery B. Nathens, MD, PhD, MPH^c,d

^a Critical Care Division, Department of Pediatrics, Children's Hospital, University of Colorado, Aurora, Colorado
^b Critical Care Division, Department of Pediatrics, Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington
^c Division of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
^d Department of Surgery, University of Toronto, Toronto, Ontario, Canada

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. Risk factors for readmission or death were identified by using a multivariate extended Cox model.

RESULTS. Overall, 7183 children were admitted with severe sepsis, 6.8% of whom died during the sentinel admission or within 28 days of discharge, whereas an additional 6.5% died subsequently. 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.

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Key Words: outcome • sepsis

Abbreviations: ICD-9—International Classification of Diseases, Ninth Revision • DRG—diagnosis-related group • HR—hazard ratio • CI—confidence interval

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Accepted Jul 2, 2008.

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