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Pediatrics. 2019 Dec;144(6). pii: e20191790. doi: 10.1542/peds.2019-1790.

A National Approach to Pediatric Sepsis Surveillance.

Author information

1
Department of Pediatrics, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts; heather.hsu@bmc.org.
2
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
3
Division of Medical Critical Care, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
4
Divisions of Emergency Medicine.
5
Division of Hospital Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
6
Division of Critical Care Medicine, Department of Pediatrics, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
7
Department of Critical Care Medicine, School of Medicine, University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
8
Division of Hospital Medicine, School of Medicine, Emory University, Atlanta, Georgia.
9
Infectious Diseases, and.
10
Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
11
Departments of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver and British Columbia's Children's Hospital, British Columbia, Canada.
12
Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
13
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
14
Department of Pediatrics, School of Medicine, Stanford University and Lucille Packard Children's Hospital, Palo Alto, California.
15
Division of Pediatric Emergency Medicine, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, Ohio; and.
16
Neonatology, and Center for Pediatric Clinical Effectiveness, Departments of Pediatrics and.
17
Departments of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.
18
Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Abstract

Pediatric sepsis is a major public health concern, and robust surveillance tools are needed to characterize its incidence, outcomes, and trends. The increasing use of electronic health records (EHRs) in the United States creates an opportunity to conduct reliable, pragmatic, and generalizable population-level surveillance using routinely collected clinical data rather than administrative claims or resource-intensive chart review. In 2015, the US Centers for Disease Control and Prevention recruited sepsis investigators and representatives of key professional societies to develop an approach to adult sepsis surveillance using clinical data recorded in EHRs. This led to the creation of the adult sepsis event definition, which was used to estimate the national burden of sepsis in adults and has been adapted into a tool kit to facilitate widespread implementation by hospitals. In July 2018, the Centers for Disease Control and Prevention convened a new multidisciplinary pediatric working group to tailor an EHR-based national sepsis surveillance approach to infants and children. Here, we describe the challenges specific to pediatric sepsis surveillance, including evolving clinical definitions of sepsis, accommodation of age-dependent physiologic differences, identifying appropriate EHR markers of infection and organ dysfunction among infants and children, and the need to account for children with medical complexity and the growing regionalization of pediatric care. We propose a preliminary pediatric sepsis event surveillance definition and outline next steps for refining and validating these criteria so that they may be used to estimate the national burden of pediatric sepsis and support site-specific surveillance to complement ongoing initiatives to improve sepsis prevention, recognition, and treatment.

PMID:
31776196
PMCID:
PMC6889946
[Available on 2020-12-01]
DOI:
10.1542/peds.2019-1790

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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