Advancing Pediatric Sepsis Knowledge

For eight years, Children’s Hospital Association (CHA) worked with hospitals in a nationwide quality improvement collaborative that aimed to reduce sepsis-attributable mortality and improve survivor outcomes. Using a data set containing over 100,000 pediatric sepsis episodes from 66 children's hospitals, the Improving Pediatric Sepsis Outcomes (IPSO) collaborative published crucial findings charting the path to better outcomes for children with sepsis. Peer-reviewed, published results include:

Detecting Sepsis in Oncology Patients: Systematic sepsis recognition tools are associated with lower sepsis-attributable mortality in hematology and oncology patients. 

Antibiotic Delays and Mortality: Delays in antibiotic administration to children who present to the ED with sepsis are associated with increased sepsis-attributable mortality. 

Characteristics of Sepsis in Pediatric Inpatients: Inpatient sepsis cases have longer lengths of stay, more need for intensive care, higher vasopressor use, and increased sepsis-attributable mortality. Mortality improves with sepsis bundle adherence.

Bundle of Care Improves Outcomes: IPSO's modified, evidence-based bundle of care, including utilization of recognition processes and timely administration of fluids and antibiotics, is associated with significantly lower sepsis-attributable mortality. 

Evaluating Pediatric Sepsis Definitions: IPSO's sepsis definitions are effective and feasible for large-scale data abstraction, identifying patients treated for sepsis, and practical use in quality improvement.

Developing a Quality Improvement Collaborative: A description of the development of the learning collaborative that details the aims and key drivers based on treatment guidelines, evidence, and baseline data.

Metric Development: A comprehensive data dictionary was developed for the largest pediatric sepsis QI collaborative, optimizing automation and ensuring sustainable reporting. These approaches can be used in other large-scale sepsis QI projects where researchers leverage EHR data abstraction.

Association Between Intravenous Fluid Volume and Mortality: In children with hypotensive septic shock, receiving a timely first-fluid bolus within the first hour of ED care is more important than the volume of fluid.