National estimates of emergency department visits for pediatric severe sepsis in the United States

Sara Singhal,John P Donnelly,Mathias W Allen,Kenneth S Smith,Henry E Wang,John-Ryan Mcannally

doi:10.7717/peerj.79

Abstract

Objective. We sought to determine the characteristics of children presenting to United States (US) Emergency Departments (ED) with severe sepsis.Study design. Cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using triage vital signs and ED diagnoses (defined by the International Classification of Diseases, Ninth Revision codes), we identified children <18 years old presenting with both infection (triage fever or ICD-9 infection) and organ dysfunction (triage hypotension or ICD-9 organ dysfunction).Results. Of 28.2 million pediatric patients presenting to US EDs each year, severe sepsis was present in 95,055 (0.34%; 95% CI: 0.29–0.39%). Fever and respiratory infection were the most common indicators of an infection. Hypotension and respiratory failure were the most common indicators of organ dysfunction. Most severe sepsis occurred in children ages 31 days–1 year old (32.1%). Most visits for pediatric severe sepsis occurred during winter months (37.4%), and only 11.1% of patients arrived at the ED by ambulance. Over half of severe sepsis cases were self-pay or insured by Medicaid. A large portion (44.1%) of pediatric severe sepsis ED visits occurred in the South census region. ED length of stay was over 3 h, and 16.5% were admitted to the hospital.Conclusion. Nearly 100,000 children annually present to US EDs with severe sepsis. The findings of this study highlight the unique characteristics of children treated in the ED for severe sepsis.

Highlights

Severe sepsis is the syndrome of systemic inflammatory response to microbial infection complicated by organ dysfunction
An estimated 1.05 billion Emergency Departments (ED) visits occurred in the U.S during the nine-year study period (2001–2009), of which 253.4 million (24.1%) involved children
Severe sepsis was present in 95,055 cases annually, representing 0.34% of all ED visits by children

Summary

Introduction

Severe sepsis is the syndrome of systemic inflammatory response to microbial infection complicated by organ dysfunction. Severe sepsis poses a major public health burden, resulting in over 750,000 hospitalizations, 500,000 Emergency Department (ED). How to cite this article Singhal et al (2013), National estimates of emergency department visits for pediatric severe sepsis in the United States. The estimated cost of adult severe sepsis in the US is over $16 billion annually (Angus et al, 2001). Watson et al estimated that there are over 42,000 annual pediatric hospital admissions for severe sepsis in the US, with a mortality rate of 10.2% (Watson & Carcillo, 2005). Children admitted with severe sepsis had an average length of stay of 31 days at a cost of over $40,000, translating to an estimated annual US cost of $1.7 billion (Watson et al, 2003)

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Conclusion