Risk Management and Healthcare Policy (Sep 2023)
Pediatric Sepsis Requiring Intensive Care Admission: Potential Structured Follow-Up Protocols to Identify and Manage New or Exacerbated Medical Conditions
Abstract
Anireddy R Reddy,1– 3 Hannah R Stinson,1,3,4 Alicia M Alcamo,1,3,4 Neethi P Pinto,1,3,4 Julie C Fitzgerald1,3,4 1Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 3Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 4Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USACorrespondence: Julie C Fitzgerald, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Main Hospital, Ninth Floor, Room 9NW41, Philadelphia, PA, 19103, USA, Tel +12156051454, Email [email protected]: Pediatric sepsis is a leading cause of morbidity and mortality in children globally. Children who require the pediatric intensive care unit (PICU) are at high risk for new or worsening co-morbidities, as well as readmission. This review describes the current state of protocolized follow-up after pediatric sepsis requiring PICU admission. We searched Medline and EMBASE databases for studies published in English from 2005 to date. Duplicates, review articles, abstracts and poster presentations were excluded; neonatal intensive care unit (NICU) patients were also excluded since neonatal sepsis is variably defined and differs from the pediatric consensus definition. The search yielded 418 studies of which 55 were duplicates; the subsequent 363 studies were screened for inclusion criteria, yielding 31 studies for which full article screening was completed. Subsequently, 23 studies were excluded due to wrong population (9), wrong publication type (10), duplicate data (3) or wrong outcome (1). In total, nine studies were included for which we described study design, setting, population, sample size, outcomes, PICU core outcome domain, and results. There were 4 retrospective cohort studies, 4 prospective cohort studies, 1 retrospective case series and no prospective trials. These studies show the varying trajectories of recovery after discharge, with the common finding that new or worsening morbidities are worse within months of discharge, but may persist. Sepsis survivors may have distinct needs and a different post-PICU trajectory compared to other critically ill children, particularly in quality of life and neurocognitive outcomes. Future research should focus on developing screening protocols and studying protocolized follow-up trials to reduce morbidity after pediatric sepsis.Keywords: children, outcome, critical care, infection
