Health Resource Use in Survivors of Pediatric Septic Shock in the United States

Abstract

To evaluate postdischarge health resource use in pediatric survivors of septic shock and determine patient and hospitalization factors associated with health resource use. DESIGN:Secondary analyses of a multicenter prospective observational cohort study. SETTING:Twelve academic PICUs. PATIENTS:Children greater than or equal to 1 month and less than 18 years old hospitalized for community-acquired septic shock who survived to 1 year. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:For 308/338 patients (91%) with baseline and greater than or equal to one postdischarge survey, we evaluated readmission, emergency department (ED) visits, new medication class, and new device class use during the year after sepsis. Using negative binomial regression with bidirectional stepwise selection, we identified factors associated with each outcome. Median age was 7 years (interquartile range, 2-13), 157 (51%) had a chronic condition, and nearly all patients had insurance (private [n = 135; 44%] or government [n = 157; 51%]). During the year after sepsis, 128 patients (42%) were readmitted, 145 (47%) had an ED visit, 156 (51%) started a new medication class, and 102 (33%) instituted a new device class. Having a complex chronic condition was independently associated with readmission and ED visit. Documented infection and higher sum of Pediatric Logistic Organ Dysfunction--2 hematologic score were associated with readmission, whereas younger age and having a noncomplex chronic condition were associated with ED visit. Factors associated with new medication class use were private insurance, neurologic insult, and longer PICU stays. Factors associated with new device class use were preadmission chemotherapy or radiotherapy, presepsis Functional Status Scale score, and ventilation duration greater than or equal to 10 days. Of patients who had a new medication or device class, most had a readmission (56% and 61%) or ED visit (62% and 67%). CONCLUSIONS:Children with septic shock represent a high-risk cohort with high-resource needs after discharge. Interventions and targeted outcomes to mitigate postdischarge resource use may differ based on patients' preexisting conditions.

Recovery Trajectories in Children Requiring 3 or More Days of Invasive Ventilation

“…Lastly, health resource use such as hospitalizations and ED visits are additional measures to evaluate long-term outcomes and, as demonstrated in this cohort and other critically ill pediatric cohorts, are frequent occurrences and likely to be highly disruptive to recovery or evidence of ongoing impairments (2, 37, 38). Furthermore, this study highlights that nearly half of patients required therapy support after discharge, further supporting the involvement of these specialists during the acute illness.…”

Resuscitation With Vitamin C, Hydrocortisone, and Thiamin in Children With Septic Shock: A Multicenter Randomized Pilot Study

“…In Australia and New Zealand (ANZ), our most contemporary data, [2006][2007][2008][2009][2010][2011][2012][2013][2014][2015][2016], indicate that about one-in-six children with septic shock admitted to the PICUs die (3). Moreover, survivors frequently suffer serious sequelae, which affect long-term health-related quality of life (4). Most children with septic shock present with rapid deterioration, and in our ANZ 2012-2015 experience, half of the deaths occurred within 48 hours of presentation (5).…”

New and Progressive Medical Conditions After Pediatric Sepsis Hospitalization Requiring Critical Care

“…Furthermore, this association persists after adjustment for acute organ dysfunction and length of hospitalization, suggesting that comorbidity development, specifically chronic respiratory failure and supplemental nutritional dependence, is not merely a reflection of severity of acute illness but is more specific to sepsis. Although prior studies have shown increased rates of health care use, hospital readmission, and new medical device dependence after sepsis (and therefore hinted at the development and progression of comorbid conditions as a driver of these outcomes), this study assessed directly for new or progressive comorbid conditions …”