Medical Student University of Virginia School of Medicine Charlottesville, Virginia, United States
Background: Sepsis remains a major cause of morbidity and mortality in children. The most severe clinical state observed in sepsis is septic shock, defined as sepsis with associated cardiovascular dysfunction. In 2005, the International Pediatric Sepsis Consensus Conference (IPSCC) defined criteria for both sepsis and cardiovascular dysfunction. In 2022, the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) published updated criteria for cardiovascular dysfunction. Objective: We sought to contrast the epidemiology of septic shock based on the IPSCC vs PODIUM criteria for cardiovascular dysfunction in a cohort of pediatric patients with sepsis. Design/Methods: Among patients admitted to the pediatric intensive care unit at our institution from June 2020 to May 2022, we included all sepsis events as defined by IPSCC criteria: both 1.) presence of systemic inflammatory response syndrome; and 2.) suspected or proven invasive infection caused by any pathogen, including administration of parenteral antibiotics and acquisition of blood culture. Sepsis events in individual patients occurring within 14 days of an index event were excluded. Individual chart review was performed to determine the presence or absence of cardiovascular dysfunction as defined by IPSCC and PODIUM criteria in the 12-hour windows preceding and following sepsis diagnosis. Results: There were 195 sepsis events in 148 unique patients included in the study with a median age of 17 months (IQR 5 months – 9 years) at the time of diagnosis. The incidence of septic shock differed based on criteria (p< 0.001): IPSCC (67 events, 34%) vs PODIUM (82 events, 42%). In terms of concordance, 84% of IPSCC events also met PODIUM criteria, while 32% of events meeting PODIUM criteria did not meet IPSCC criteria. Controlling for patient-level effects, septic shock-associated case fatality was 24% using IPSCC criteria vs 22% using PODIUM criteria.
Conclusion(s): We observed an increased incidence of septic shock among sepsis events using the updated PODIUM criteria. The PODIUM criteria are broader in terms of scope and number of criterions employed and are likely more reflective of the current state of pediatric critical care practice. Despite the difference in incidence, case fatality rates were similar between the two criteria.