Children with Sepsis Directly Admitted to a Children's Hospital Have a Lower Mortality Compared to Those Transferred from Outside Emergency Departments

Abstract

AbstractSepsis, severe sepsis, and septic shock are associated with high morbidity and mortality in children. We investigated the association between clinical outcomes and location of initial emergency department (ED) presentation for critically ill children with sepsis. Using the Virtual Pediatric Systems (VPS) database, we performed a 10-year retrospective cohort study of children (aged 30 days to 18 years) admitted to a VPS pediatric intensive care unit (PICU) with a primary diagnosis of sepsis, severe sepsis, or septic shock. We compared mortality, length of stay, and ventilator-free days of those who were transferred to a VPS PICU from a referring hospital ED to those who were directly admitted from the VPS PICU's hospital ED. Of the 9,833 patients, 26% were admitted from a referring ED. Overall PICU mortality was 6.3%. Transferred patients had a higher probability of death based on Pediatric Index of Mortality 3 (PIM 3) scoring (1.2 vs. 1.0; p < 0.001), longer ICU length of stay (LOS; 3vs. 2 days; p < 0.001), and were more likely to require mechanical ventilation (50 vs. 35%; p < 0.001). Direct admission from the VPS PICU's ED was independently associated with lower mortality (odds ratio [OR]: 0.81; p = 0.041) and shorter ICU LOS (21%; p = 0.009). Hospital LOS and ventilator-free days were not independently associated with the location of the initial ED presentation. In this cohort of children with sepsis, severe sepsis, and septic shock, location of initial care impacted patient outcomes. Compared to children transferred from a referring ED, children directly admitted from a VPS PICU hospital's ED had improved mortality and decreased ICU LOS.