Journal article
Comparison of Pediatric Severe Sepsis Managed in US and European ICUs
Pediatric critical care medicine, Vol.17(6), pp.522-530
06/01/2016
DOI: 10.1097/PCC.0000000000000760
PMCID: PMC5399539
PMID: 27124566
Abstract
Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies.
Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality.
Setting: European and U.S. PICUs.
Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study.
Interventions: None.
Measurements and Main Results: European PICUs had fewer beds ( median, 11 vs 24; p < 0.001). European patients were younger ( median, 1 vs 6 yr; p < 0.001), had higher severity of illness ( median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward ( 37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients ( 85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U. S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days.
Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.
Details
- Title: Subtitle
- Comparison of Pediatric Severe Sepsis Managed in US and European ICUs
- Creators
- John S. Giuliano - Yale UniversityBarry P. Markovitz - University of Southern CaliforniaJoe Brierley - Great Ormond Street HospitalRichard Levin - Royal Hospital for ChildrenGary Williams - Sydney Children’s Hospitals NetworkLucy Chai See Lum - Univ Malaya, Med Ctr, Dept Pediat, Kuala Lumpur, MalaysiaTavey Dorofaeff - Children's Health Queensland Hospital and Health ServicePablo Cruces - Universidad Andrés BelloJenny L. Bush - Children's Hospital of PhiladelphiaLuke Keele - Pennsylvania State UniversityVinay M. Nadkarni - Children's Hospital of PhiladelphiaNeal J. Thomas - Penn State Milton S. Hershey Medical CenterJulie C. Fitzgerald - University of PennsylvaniaScott L. Weiss - University of PennsylvaniaOUtcomes Study Investigator
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.17(6), pp.522-530
- DOI
- 10.1097/PCC.0000000000000760
- PMID
- 27124566
- PMCID
- PMC5399539
- NLM abbreviation
- Pediatr Crit Care Med
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- Southampton NIHR Welcome Trust Clinical Research Facility Research Councils UK (RCUK); UK Research & Innovation (UKRI) K12HD047349; NIGMS K23GM110496 / National Institute of Child Health and Human Development; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) R01 / FDA; United States Department of Health & Human Services; US Food & Drug Administration (FDA) Center for Pediatric Clinical Effectiveness at The Children's Hospital of Philadelphia Picwell Corp Department of Labor Department of Anesthesia and Critical Care, University of Pennsylvania Perelman School of Medicine National Institutes of Health (NIH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Wellcome Trust/COAF; Wellcome Trust
- Language
- English
- Date published
- 06/01/2016
- Academic Unit
- Stead Family Department of Pediatrics
- Record Identifier
- 9984354038802771
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