Study: Nearly 4% of publicly insured US kids with sepsis die, with some at higher risk
Chris Dall, MA10 minutes ago.
Sepsis
Nearly 4% of publicly insured children with sepsis in the United States died within 30 days of hospitalization over a two-year period, with significant regional variation in death rates, according to a study published today in Pediatrics.
Sepsis occurs when the immune system overreacts to an infection, triggering a chain of events that can lead to tissue damage, organ failure, and death. At least one in five adults with sepsis die during hospitalization. While timely recognition and treatment of sepsis is critical for patients of all ages, it’s particularly challenging in children, because there’s no single diagnostic marker, and symptoms often overlap with common, low-severity childhood illnesses.
Since most children with community-acquired sepsis are initially treated in emergency departments (EDs) at community hospitals before being sent to regional referral centers, a team led by researchers with Northwestern University Feinberg School of Medicine wanted to evaluate regional variations in pediatric sepsis outcomes to see if they could identify high- and low-performing regions. They focused on publicly insured children, because state Medicaid programs insure nearly half of US children, and Medicaid has been associated with both higher rates of chronic disease and higher odds of misdiagnosis for pediatric sepsis in EDs.
“Because Medicaid is the most prevalent form of insurance in the United States, and because of the increased illness burden and likelihood of misdiagnosis, children with public insurance represent a critical population in which to evaluate sepsis incidence, regional variation, and longitudinal outcomes,” they wrote.
Much regional variation, with high- and low-mortality outliers
Using Medicaid data covering 2021 to 2023 on children younger than 19 who were hospitalized with sepsis, the researchers identified 63,337 sepsis episodes, of which 40,524 were community-acquired. Overall, episodes occurred most frequently in boys (52.8%), Hispanic children (26.5%), and children aged 1 to 4 years (23.8%).Death within 30 days occurred in 1,562 (3.9%) of community-acquired sepsis episodes and was more common in children with complex chronic conditions (CCCs) than those without (4.9% vs 1.3%). Cardiovascular, malignancy, metabolic, neuromuscular, and renal CCCs were all independently associated with death within 30 days. Rehospitalization occurred after 16.7% of hospitalizations.
Regional standardized mortality rates ranged from 0.00% to 3.82%, with no clear geographic pattern; 14 regions had lower-than-expected mortality, and 12 regions had higher-than-expected mortality. Regions with a children’s hospital (adjusted odds ratio [aOR], 0.76) and higher sepsis incidence (aOR, 0.91) were associated with lower death rates. Among the 14 low-mortality regions, 10 (71%) contained at least one children’s hospital.
The authors note that the sepsis mortality observed in the cohort—2.31 deaths per 100,000 person-years—is comparable to the leading causes of childhood death in 2023, including firearms (5.72), malignancies (2.30), and poisonings (2.45). They say the regions that were high-mortality outliers may represent the best opportunity for targeted improvements in pediatric sepsis care.
“These findings suggest that pediatric sepsis outcomes are influenced not only by patient-level risk factors but also by regional systems of care and experience, underscoring an opportunity for targeted, regionally focused interventions to reduce preventable pediatric sepsis deaths,” the authors wrote.
