Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs

Abstract

Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies.; Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality.; Setting: European and U.S. PICUs.; Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study.; Interventions: None.; Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days.; Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.Lancet. 2015 Jan 31;385(9966):430-40. (PMID: 25280870); Lancet. 2003 Jul 19;362(9379):192-7. (PMID: 12885479); Crit Care Med. 1994 Jun;22(6):1025-31. (PMID: 8205810); Pediatr Crit Care Med. 2015 Jun;16(5):410-7. (PMID: 25739013); Lancet. 2014 Sep 13;384(9947):957-79. (PMID: 24797572); Lancet Infect Dis. 2015 May;15(5):581-614. (PMID: 25932591); Pediatr Crit Care Med. 2012 Sep;13(5):501-8. (PMID: 22460772); Lancet Infect Dis. 2012 Dec;12(12):919-24. (PMID: 23103175); Am J Respir Crit Care Med. 2015 May 15;191(10):1147-57. (PMID: 25734408); Indian J Pediatr. 2015 Aug;82(8):698-702. (PMID: 25429997); Clin Microbiol Infect. 2013 Jun;19(6):501-9. (PMID: 23473333); Pediatr Crit Care Med. 2013 Sep;14(7):686-93. (PMID: 23897242); Pediatr Crit Care Med. 2005 Jan;6(1):2-8. (PMID: 15636651); Pediatr Crit Care Med. 2014 Nov;15(9):828-38. (PMID: 25226500); Pediatr Crit Care Med. 2005 May;6(3 Suppl):S3-5. (PMID: 15857554); Crit Care Med. 2015 Jun;43(6):1239-45. (PMID: 25756414); Pediatr Crit Care Med. 2014 Sep;15(7):660-6. (PMID: 24751790); Pediatr Crit Care Med. 2013 Sep;14(7):673-81. (PMID: 23863821); Pediatr Crit Care Med. 2014 Nov;15(9):798-805. (PMID: 25162514). Linking ISSN: 15297535. Subset: MEDLINE; Grant Information: United Kingdom Wellcome Trust; K12 HD047349 United States HD NICHD NIH HHS; K23 GM110496 United States GM NIGMS NIH HHS; United Kingdom Department of Health Date of Electronic Publication: 20160601. ; Original Imprints: Publication: Baltimore, MD : Lippincott Williams & Wilkins, c2000- <br />