Back to Search
Start Over
Transfer hospitalizations for pediatric severe sepsis or septic shock: resource use and outcomes.
- Source :
-
BMC pediatrics [BMC Pediatr] 2019 Jun 13; Vol. 19 (1), pp. 196. Date of Electronic Publication: 2019 Jun 13. - Publication Year :
- 2019
-
Abstract
- Background: Sepsis is a major cause of child mortality and morbidity. To enhance outcomes, children with severe sepsis or septic shock often require escalated care for organ support, sometimes necessitating interhospital transfer. The association between transfer admission for the care of pediatric severe sepsis or septic shock and in-hospital patient survival and resource use is poorly understood.<br />Methods: Retrospective study of children 0-20 years old hospitalized for severe sepsis or septic shock, using the 2012 Kids' Inpatient Database. After descriptive and bivariate analysis, multivariate regression methods assessed the independent relationship between transfer status and outcomes of in-hospital mortality, duration of hospitalization, and hospital charges, after adjustment for potential confounders including illness severity.<br />Results: Of an estimated 11,922 hospitalizations (with transfer information) for pediatric severe sepsis and septic shock nationally in 2012, 25% were transferred, most often to urban teaching hospitals. Compared to non-transferred children, transferred children were younger, and had a higher frequency of extreme illness severity (84% vs. 75%, p < .01), and of multiple organ dysfunction (32% vs. 24%, p < .01). They also had higher use of invasive medical devices including arterial catheters, invasive mechanical ventilation, and central venous catheters; and of specialized technology, including renal replacement therapy (6.2% vs. 4.6%, p < .01) and extracorporeal membrane oxygenation (5.7% vs. 1.8%, p < .01). Transferred children had longer hospitalization and accrued higher charges than non-transferred children (p < .01). Crude mortality was higher among transferred than non-transferred children (21.4% vs.15.0%, p < .01), a difference no longer statistically significant after multivariate adjustment for potential confounders (Odds Ratio:1.04, 95% Confidence interval: 0.88-1.24). Similarly, adjusted length of hospital stay and hospital charges were not statistically different by transfer status.<br />Conclusion: One in four children with severe sepsis or septic shock required interhospital transfer for specialized care associated with greater use of invasive medical devices and specialized technology. Despite higher crude mortality and resource consumption among transferred children, adjusted mortality and resource use did not differ by transfer status. Further research should identify quality-of-care factors at the receiving hospitals that influence clinical outcomes and resource use.
- Subjects :
- Adolescent
Catheterization statistics & numerical data
Child
Child, Preschool
Confidence Intervals
Databases, Factual
Extracorporeal Membrane Oxygenation statistics & numerical data
Female
Hospital Charges
Hospitals, Teaching statistics & numerical data
Hospitals, Urban statistics & numerical data
Humans
Infant
Infant, Newborn
Length of Stay
Male
Multiple Organ Failure epidemiology
Odds Ratio
Regression Analysis
Renal Replacement Therapy statistics & numerical data
Respiration, Artificial statistics & numerical data
Retrospective Studies
Severity of Illness Index
Treatment Outcome
United States
Young Adult
Hospital Mortality
Hospitalization economics
Hospitalization statistics & numerical data
Patient Transfer statistics & numerical data
Sepsis mortality
Shock, Septic mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2431
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 31196011
- Full Text :
- https://doi.org/10.1186/s12887-019-1577-5