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Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study.

Publication ,  Journal Article
Weiss, SL; Fitzgerald, JC; Maffei, FA; Kane, JM; Rodriguez-Nunez, A; Hsing, DD; Franzon, D; Kee, SY; Bush, JL; Roy, JA; Thomas, NJ ...
Published in: Crit Care
September 16, 2015

INTRODUCTION: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). METHODS: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. RESULTS: Of the 706 patients, 301 (42.6%) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69% (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. CONCLUSIONS: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.

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Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

September 16, 2015

Volume

19

Issue

1

Start / End Page

325

Location

England

Related Subject Headings

  • Treatment Outcome
  • Sepsis
  • Prevalence
  • Practice Patterns, Physicians'
  • Observer Variation
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Female
 

Citation

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Chicago
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Weiss, S. L., Fitzgerald, J. C., Maffei, F. A., Kane, J. M., Rodriguez-Nunez, A., Hsing, D. D., … SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network, . (2015). Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care, 19(1), 325. https://doi.org/10.1186/s13054-015-1055-x
Weiss, Scott L., Julie C. Fitzgerald, Frank A. Maffei, Jason M. Kane, Antonio Rodriguez-Nunez, Deyin D. Hsing, Deborah Franzon, et al. “Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study.Crit Care 19, no. 1 (September 16, 2015): 325. https://doi.org/10.1186/s13054-015-1055-x.
Weiss SL, Fitzgerald JC, Maffei FA, Kane JM, Rodriguez-Nunez A, Hsing DD, et al. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care. 2015 Sep 16;19(1):325.
Weiss, Scott L., et al. “Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study.Crit Care, vol. 19, no. 1, Sept. 2015, p. 325. Pubmed, doi:10.1186/s13054-015-1055-x.
Weiss SL, Fitzgerald JC, Maffei FA, Kane JM, Rodriguez-Nunez A, Hsing DD, Franzon D, Kee SY, Bush JL, Roy JA, Thomas NJ, Nadkarni VM, SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care. 2015 Sep 16;19(1):325.

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

September 16, 2015

Volume

19

Issue

1

Start / End Page

325

Location

England

Related Subject Headings

  • Treatment Outcome
  • Sepsis
  • Prevalence
  • Practice Patterns, Physicians'
  • Observer Variation
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Female