Introduction
Sepsis remains a major cause of mortality in pediatric intensive care units (PICUs). Guidelines emphasize early recognition to facilitate timely intervention and improve patient outcomes. Utilizing data from the Improving Pediatric Sepsis Outcomes (IPSO) Collaborative, we assessed the relationship between PICU sepsis recognition compliance—defined by a positive sepsis screen, huddle, or sepsis order set—and patient outcomes. Additionally, we analyzed differences in clinical characteristics between early-onset sepsis (EO; occurring within 12 hours of hospital arrival) and hospital-onset sepsis (HO; occurring after 12 hours).
Method
This retrospective cohort study analyzed IPSO critical sepsis (ICS) cases in the PICU from 2017-2023, identified based on vasoactive medication use or third fluid bolus administration. Patient demographics, clinical characteristics, and outcomes were compared using descriptive statistics, Pearson Chi-square, and Wilcoxon rank sum tests.
Results
Among 4,649 ICS cases, 1,522 (32.7%) were EO, and 3,127 (67.3%) were HO. Recognition compliance reduced 30-day sepsis-attributable mortality in HO sepsis (7.8% vs. 10.3%, p=0.042) but not in EO cases. Recognized HO cases had more ICU-free (14 vs. 10 days, p<0.001) and ventilator-free days (18 vs. 14 days, p=0.004). Recognition rates were lower in HO (26.8%) than EO sepsis (36.7%, p<0.001), likely due to more high-risk conditions such as central lines, immunosuppression, and technology dependence (34.3% vs. 22.9%, p<0.001).
Conclusion
Recognition was linked to lower sepsis-attributable mortality in hospital-onset (HO) sepsis within the PICU. However, recognition rates for HO sepsis were lower than for early-onset (EO) sepsis, likely due to the higher prevalence of high-risk conditions in HO patients. Enhancing the integration of effective recognition tools into PICU workflows is essential to improve early detection and outcomes for HO sepsis cases.
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