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

John S. Giuliano, Barry P. Markovitz, Joe Brierley, Richard Levin, Gary Williams, Lucy Chai See Lum, Tavey Dorofaeff, Pablo Cruces, Jenny L. Bush, Luke Keele, Vinay M. Nadkarni, Neal J. Thomas, Julie C. Fitzgerald, Scott L. Weiss, P. Fontela, M. Tucci, M. Dumistrascu, P. Skippen, G. Krahn, E. BezaresG. Puig, A. Puig-Ramos, R. Garcia, M. Villar, M. Bigham, T. Polanski, S. Latifi, D. Giebner, H. Anthony, J. Hume, A. Galster, L. Linnerud, R. Sanders, G. Hefley, K. Madden, A. Thompson, S. Shein, S. Gertz, Y. Han, T. Williams, A. Hughes-Schalk, H. Chandler, A. Orioles, E. Zielinski, A. Doucette, A. Orioles, M. Di Nardo, S. Picardo, T. Fragasso, P. Cogo, Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)522-530
Number of pages9
JournalPediatric Critical Care Medicine
Volume17
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

Fingerprint

Sepsis
Pediatrics
Mortality
Morbidity
Outcome Assessment (Health Care)
Clinical Trials
Therapeutics
Mechanical Ventilators
Critical Care
Artificial Respiration
Multicenter Studies
Length of Stay
Demography

Keywords

  • children
  • Europe
  • management
  • outcome
  • pediatric intensive care unit
  • shock

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)
  • Critical Care and Intensive Care Medicine

Cite this

Giuliano, J. S., Markovitz, B. P., Brierley, J., Levin, R., Williams, G., Lum, L. C. S., ... Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network (2016). Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs. Pediatric Critical Care Medicine, 17(6), 522-530. https://doi.org/10.1097/PCC.0000000000000760

Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs. / Giuliano, John S.; Markovitz, Barry P.; Brierley, Joe; Levin, Richard; Williams, Gary; Lum, Lucy Chai See; Dorofaeff, Tavey; Cruces, Pablo; Bush, Jenny L.; Keele, Luke; Nadkarni, Vinay M.; Thomas, Neal J.; Fitzgerald, Julie C.; Weiss, Scott L.; Fontela, P.; Tucci, M.; Dumistrascu, M.; Skippen, P.; Krahn, G.; Bezares, E.; Puig, G.; Puig-Ramos, A.; Garcia, R.; Villar, M.; Bigham, M.; Polanski, T.; Latifi, S.; Giebner, D.; Anthony, H.; Hume, J.; Galster, A.; Linnerud, L.; Sanders, R.; Hefley, G.; Madden, K.; Thompson, A.; Shein, S.; Gertz, S.; Han, Y.; Williams, T.; Hughes-Schalk, A.; Chandler, H.; Orioles, A.; Zielinski, E.; Doucette, A.; Orioles, A.; Di Nardo, M.; Picardo, S.; Fragasso, T.; Cogo, P.; Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network.

In: Pediatric Critical Care Medicine, Vol. 17, No. 6, 01.06.2016, p. 522-530.

Research output: Contribution to journalArticle

Giuliano, JS, Markovitz, BP, Brierley, J, Levin, R, Williams, G, Lum, LCS, Dorofaeff, T, Cruces, P, Bush, JL, Keele, L, Nadkarni, VM, Thomas, NJ, Fitzgerald, JC, Weiss, SL, Fontela, P, Tucci, M, Dumistrascu, M, Skippen, P, Krahn, G, Bezares, E, Puig, G, Puig-Ramos, A, Garcia, R, Villar, M, Bigham, M, Polanski, T, Latifi, S, Giebner, D, Anthony, H, Hume, J, Galster, A, Linnerud, L, Sanders, R, Hefley, G, Madden, K, Thompson, A, Shein, S, Gertz, S, Han, Y, Williams, T, Hughes-Schalk, A, Chandler, H, Orioles, A, Zielinski, E, Doucette, A, Orioles, A, Di Nardo, M, Picardo, S, Fragasso, T, Cogo, P & Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network 2016, 'Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs', Pediatric Critical Care Medicine, vol. 17, no. 6, pp. 522-530. https://doi.org/10.1097/PCC.0000000000000760
Giuliano JS, Markovitz BP, Brierley J, Levin R, Williams G, Lum LCS et al. Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs. Pediatric Critical Care Medicine. 2016 Jun 1;17(6):522-530. https://doi.org/10.1097/PCC.0000000000000760
Giuliano, John S. ; Markovitz, Barry P. ; Brierley, Joe ; Levin, Richard ; Williams, Gary ; Lum, Lucy Chai See ; Dorofaeff, Tavey ; Cruces, Pablo ; Bush, Jenny L. ; Keele, Luke ; Nadkarni, Vinay M. ; Thomas, Neal J. ; Fitzgerald, Julie C. ; Weiss, Scott L. ; Fontela, P. ; Tucci, M. ; Dumistrascu, M. ; Skippen, P. ; Krahn, G. ; Bezares, E. ; Puig, G. ; Puig-Ramos, A. ; Garcia, R. ; Villar, M. ; Bigham, M. ; Polanski, T. ; Latifi, S. ; Giebner, D. ; Anthony, H. ; Hume, J. ; Galster, A. ; Linnerud, L. ; Sanders, R. ; Hefley, G. ; Madden, K. ; Thompson, A. ; Shein, S. ; Gertz, S. ; Han, Y. ; Williams, T. ; Hughes-Schalk, A. ; Chandler, H. ; Orioles, A. ; Zielinski, E. ; Doucette, A. ; Orioles, A. ; Di Nardo, M. ; Picardo, S. ; Fragasso, T. ; Cogo, P. ; Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. / Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs. In: Pediatric Critical Care Medicine. 2016 ; Vol. 17, No. 6. pp. 522-530.
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T1 - Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs

AU - Giuliano, John S.

AU - Markovitz, Barry P.

AU - Brierley, Joe

AU - Levin, Richard

AU - Williams, Gary

AU - Lum, Lucy Chai See

AU - Dorofaeff, Tavey

AU - Cruces, Pablo

AU - Bush, Jenny L.

AU - Keele, Luke

AU - Nadkarni, Vinay M.

AU - Thomas, Neal J.

AU - Fitzgerald, Julie C.

AU - Weiss, Scott L.

AU - Fontela, P.

AU - Tucci, M.

AU - Dumistrascu, M.

AU - Skippen, P.

AU - Krahn, G.

AU - Bezares, E.

AU - Puig, G.

AU - Puig-Ramos, A.

AU - Garcia, R.

AU - Villar, M.

AU - Bigham, M.

AU - Polanski, T.

AU - Latifi, S.

AU - Giebner, D.

AU - Anthony, H.

AU - Hume, J.

AU - Galster, A.

AU - Linnerud, L.

AU - Sanders, R.

AU - Hefley, G.

AU - Madden, K.

AU - Thompson, A.

AU - Shein, S.

AU - Gertz, S.

AU - Han, Y.

AU - Williams, T.

AU - Hughes-Schalk, A.

AU - Chandler, H.

AU - Orioles, A.

AU - Zielinski, E.

AU - Doucette, A.

AU - Orioles, A.

AU - Di Nardo, M.

AU - Picardo, S.

AU - Fragasso, T.

AU - Cogo, P.

AU - Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

KW - children

KW - Europe

KW - management

KW - outcome

KW - pediatric intensive care unit

KW - shock

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