Characteristics and Outcomes of Young Adult Patients with Severe Sepsis Admitted to Pediatric Intensive Care Units Versus Medical/Surgical Intensive Care Units

Abstract

Purpose: Young adults receive severe sepsis treatment across pediatric and adult care settings. However, little is known about young adult sepsis outcome differences in pediatric versus adult hospital settings. Material and Methods: Using Truven MarketScan database from 2010-2015, we compared in-hospital mortality and hospital length of stay in young adults ages 18-26 treated for severe sepsis in Pediatric Intensive Care Units (PICUs) versus Medical ICUs (MICUs)/Surgical ICUs (SICUs) using logistic regression models and accelerated time failure models, respectively. Comorbidities were identified using Complex Chronic Conditions (CCC) and Charlson Comorbidity Index (CCI). Results: Of the 18 900 young adults hospitalized with severe sepsis, 163 (0.9%) were treated in the PICU and 952 (5.0%) in the MICU/SICU. PICU patients were more likely to have a comorbid condition compared to MICU/SICU patients. Compared to PICU patients, MICU/SICU patients had a lower odds of in-hospital mortality after adjusting for age, sex, Medicaid status, and comorbidities (adjusting for CCC, odds ratio [OR]: 0.50, 95% CI 0.29-0.89; adjusting for CCI, OR: 0.51, 95% CI 0.29-0.94). There was no difference in adjusted length of stay for young adults with severe sepsis (adjusting for CCC, Event Time Ratio [ETR]: 1.14, 95% CI 0.94-1.38; adjusting for CCI, ETR: 1.09, 95% CI 0.90-1.33). Conclusions: Young adults with severe sepsis experience higher adjusted odds of mortality when treated in PICUs versus MICU/SICUs. However, there was no difference in length of stay. Variation in mortality is likely due to significant differences in the patient populations, including comorbidity status.

Keywords

sepsis young adult intensive care mortality length of stay

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References

Angus

Linde-Zwirble

Lidicker

Clermont

Carcillo

Pinsky

. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303‐1310.

Martin

Mannino

Eaton

Moss

. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546‐1554.

Balamuth

Weiss

Neuman

, et al. Pediatric severe sepsis in U.S. children’s hospitals. Pediatr Crit Care Med. 2014;15(9):798‐805.

Hartman

Linde-Zwirble

Angus

Watson

. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013;14(7):686‐693.

Carlton

Barbaro

Iwashyna

Prescott

. Cost of pediatric severe sepsis hospitalizations. JAMA Pediatr. 2019;173(10):986.

Paoli

Reynolds

Sinha

Gitlin

Crouser

. Epidemiology and costs of sepsis in the United States-an analysis based on timing of diagnosis and severity level. Crit Care Med. 2018;46(12):1889‐1897.

Lagu

Rothberg

Shieh

M-S

Pekow

Steingrub

Lindenauer

. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012;40(3):754‐761.

Ruth

McCracken

Fortenberry

Hall

Simon

Hebbar

. Pediatric severe sepsis: current trends and outcomes from the pediatric health information systems database. Pediatr Crit Care Med. 2014;15(9):828‐838.

Edwards

Houtrow

Vasilevskis

Dudley

Okumura

. Multi-institutional profile of adults admitted to pediatric intensive care units. JAMA Pediatr. 2013;167(5):436‐443.

10.

Edwards

Vasilevskis

Yoo

, et al. Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units. J Crit Care. 2015;30(1):201‐206.

11.

Fuhrman

Kane-Gill

Goldstein

Priyanka

Kellum

. Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit. Ann Intensive Care. 2018;8(1):26.

12.

Burns

EJS

Meyer

Lewis-Newby

Truog

. Epidemiology of death in the PICU at five U.S. teaching hospitals*. Criti Care Med. 2014;42(9):2101‐2108.

13.

Rudd

Johnson

Agesa

, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet Lond Engl. 2020;395(10219):200‐211.

14.

Bouza

López-Cuadrado

. Epidemiology and trends of sepsis in young adults aged 20–44 years: a nationwide population-based study. J Clin Med. 2019;9(1):77.

15.

Truven Health Marketscan Research Database. Commercial Claims and Encounters Medicare Supplement. Available at: https://theclearcenter.org/wp-content/uploads/2020/01/IBM-MarketScan-User-Guide.pdf. Accessed September 2019.

16.

IBM MarketScan Research Databases for life sciences researchers. Available at: https://www.ibm.com/downloads/cas/OWZWJ0QO. Accessed September 2019.

17.

White

Cooley

. Transitions clinical report authoring group; American academy of pediatrics; American academy of family physicians; American college of physicians: supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2018;142(5):e20182587.

18.

Dombrovskiy

Martin

Sunderram

Paz

. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35(5):1244‐1250.

19.

Jolley

Sawka

Yergens

, et al. Validity of administrative data in recording sepsis: a systematic review. Critical Care. 2015;19(1):139.

20.

Morgan

Roberts

. Maternal sepsis. Obstet Gynecol Clin North Am. 2013;40(1):69‐87.

21.

Feudtner

Feinstein

Zhong

Hall

Dai

. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014;14(1):199.

22.

Charlson

Pompei

Ales

MacKenzie

. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373‐383.

23.

Deyo

Cherkin

Ciol

. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613‐619.

24.

Musumeci

Chidambaram

. Medicaid’s role for children with special health care needs: a look at eligibility, services, and spending. Available at: https://www.kff.org/medicaid/issue-brief/medicaids-role-for-children-with-special-health-care-needs-a-look-at-eligibility-services-and-spending/. Accessed March 1, 2021.

25.

Klein

Moeschberger

. Survival Analysis: Techniques for Censored and Truncated Data. Vol 1230. Springer; 2003: p 394.

26.

O’Brien

Nadel

Almossawi

Inwald

. The impact of chronic health conditions on length of stay and mortality in a general PICU. Pediatr Crit Care Med. 2017;18(1):1‐7.

27.

Yang

Hsann

Lim

Ong

. The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis. J Crit Care. 2010;25(3):398‐405.

28.

Oltean

Ţǎţulescu

Bondor

, et al. Charlson’s weighted index of comorbidities is useful in assessing the risk of death in septic patients. J Crit Care. 2012;27(4):370‐375.

29.

Carlton

Kohne

Shankar-Hari

Prescott

. Readmission diagnoses after pediatric severe sepsis hospitalization. Crit Care Med. 2019;47(4):583‐590.

30.

Cogo

Poole

Codazzi

, et al. Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007. Intensive Care Med. 2010;36(8):1403‐1409.

31.

Jan

Slap

Smith-Whitley

Dai

Keren

Rubin

. Association of hospital and provider types on sickle cell disease outcomes. Pediatrics. 2013;132(5):854‐861.

32.

Redington

. Intensive care in the adult with congenital heart disease. Pediatr Crit Care Med. 2016(8 Suppl 1):S377‐82.

33.

Karamlou

Diggs

Ungerleider

Welke

. Adults or big kids: what is the ideal clinical environment for management of grown-up patients with congenital heart disease? Ann Thorac Surg. 2010;90(2):573‐579.

34.

Jan

Slap

Dai

Rubin

. Variation in surgical outcomes for adolescents and young adults with inflammatory bowel disease. Pediatrics. 2013;131(Supplement 1):S81‐S89.

35.

Okumara

Campbell

Nasr

Davis

. Inpatient health care use among adult survivors of chronic childhood illnesses in the United States. Arch Pediatr Adolesc Med. 2006;160(10):1054.

36.

Jenkins

Berry

Perrin

, et al.

What types of hospitals do adolescents and young adults with complex chronic conditions use?

Acad Pediatr. Published online December 20, 2021. doi:10.1016/j.acap.2021.12.020

37.

Bhatt

. The epidemiology of neuromuscular diseases. Neurol Clin. 2016;34(4):999‐1021.

38.

Yates

Festa

Gillis

Waters

North

. Outcome of children with neuromuscular disease admitted to paediatric intensive care. Arch Dis Child. 2004;89(2):170‐175.

39.

Perrin

Unterborn

Ambrosio

Hill

. Pulmonary complications of chronic neuromuscular diseases and their management. Muscle Nerve. 2004;29(1):5‐27.

40.

Singer

Deutschman

Seymour

, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801‐810.

41.

Matics

Sanchez-Pinto

. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children. JAMA Pediatr. 2017;171(10):e172352.

42.

Goldstein

Giroir

Randolph

. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2‐8.

43.

Schlapbach

Kissoon

. Defining pediatric sepsis. JAMA Pediatr. 2018;172(4):313.

44.

Rhodes

Evans

Alhazzani

, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486‐552.

45.

Weiss

Peters

Alhazzani

, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21(2):e52.

46.

Dellinger

Levy

Rhodes

, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165‐228.

47.

Evans

Rhodes

, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063‐e1143.

48.

Rhee

Dantes

Epstein

, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA. 2017;318(13):1241‐1249.

49.

Gaieski

Edwards

Kallan

Carr

. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41(5):1167‐1174.

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