National trends in pediatric sepsis hospitalizations, case mix, and mortality, 2016-2022.

Abstract

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. We evaluated changes in hospitalizations for children with sepsis between 2016 and 2022 and investigated factors associated with in-hospital mortality. We performed a retrospective study using the 2016, 2019, and 2022 Kids' Inpatient Database. Our population of interest was non-newborn admissions for children (<18 years) admitted to US hospitals. We reported changes in admissions for sepsis over time, changes in population-adjusted sepsis admission rates. We identified factors associated with mortality among children with sepsis in nested models. Of 4,987,652 weighted non-newborn hospitalizations, 77,864 had sepsis. Sepsis-related admissions increased from 1.15% (95% confidence interval [CI]: 1.05%-1.25%) in 2016 to 1.90% (95% CI: 1.67%-2.11%) in 2022 (relative proportion 1.65; 95% CI: 1.41-1.89). Nationally, sepsis admissions increased from 0.28 per 1000 child-years in 2016 to 0.40 per 1000 child-years (rate ratio 1.46; 95% CI: 1.18-1.82). In-hospital mortality occurred in 2.8%. Factors positively associated with mortality included Asian or Pacific Islander (odds ratio [OR]: 1.55; 95% CI: 1.22-1.97) and Black (OR: 1.26; 95% CI: 1.08-1.48) race relative to White race, several types of medical complexity, transfer from an acute care hospital (OR: 2.12; 95% CI: 1.86-2.40) or another facility (OR 1.50; 95% CI: 1.11-2.03), and admission to an urban teaching hospital versus a rural hospital (OR: 2.08; 95% CI: 1.20-3.61). Sepsis accounts for an increasing proportion of admissions and accounts for a greater number of population-adjusted hospitalizations. Variation in mortality by race suggests modifiable drivers of outcomes.