Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.

Original languageEnglish (US)
Article number325
JournalCritical Care
Volume19
Issue number1
DOIs
StatePublished - Sep 16 2015

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Sepsis
Cross-Sectional Studies
Pediatrics
Physicians
Pediatric Intensive Care Units
Research
Mortality
Critical Illness
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2015). Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Critical Care, 19(1), [325]. https://doi.org/10.1186/s13054-015-1055-x

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. / for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

In: Critical Care, Vol. 19, No. 1, 325, 16.09.2015.

Research output: Contribution to journalArticle

for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network 2015, 'Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study', Critical Care, vol. 19, no. 1, 325. https://doi.org/10.1186/s13054-015-1055-x
for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Critical Care. 2015 Sep 16;19(1). 325. https://doi.org/10.1186/s13054-015-1055-x
for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. / Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. In: Critical Care. 2015 ; Vol. 19, No. 1.
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title = "Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study",
abstract = "Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 {\%}) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 {\%} (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.",
author = "{for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network} and Weiss, {Scott L.} and Fitzgerald, {Julie C.} and Maffei, {Frank A.} and Kane, {Jason M.} and Antonio Rodriguez-Nunez and Hsing, {Deyin D.} and Deborah Franzon and Kee, {Sze Ying} and Bush, {Jenny L.} and Roy, {Jason A.} and Thomas, {Neal J.} and Nadkarni, {Vinay M.} and P. Fontela and M. Tucci and M. Dumistrascu and P. Skippen and G. Krahn and E. Bezares and G. Puig and A. Puig-Ramos and R. Garcia and M. Villar and M. Bigham and T. Polanski and S. Latifi and D. Giebner and H. Anthony and J. Hume and A. Galster and L. Linnerud and R. Sanders and G. Hefley and K. Madden and A. Thompson and S. Shein and S. Gertz and Y. Han and T. Williams and A. Hughes-Schalk and H. Chandler and A. Orioles and E. Zielinski and A. Doucette and A. Orioles and E. Zielinski and A. Doucette and C. Zebuhr and T. Wilson and Dai Kimura and Samir Shah",
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T1 - Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

AU - for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

AU - Weiss, Scott L.

AU - Fitzgerald, Julie C.

AU - Maffei, Frank A.

AU - Kane, Jason M.

AU - Rodriguez-Nunez, Antonio

AU - Hsing, Deyin D.

AU - Franzon, Deborah

AU - Kee, Sze Ying

AU - Bush, Jenny L.

AU - Roy, Jason A.

AU - Thomas, Neal J.

AU - Nadkarni, Vinay M.

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 - Zielinski, E.

AU - Doucette, A.

AU - Zebuhr, C.

AU - Wilson, T.

AU - Kimura, Dai

AU - Shah, Samir

PY - 2015/9/16

Y1 - 2015/9/16

N2 - Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.

AB - Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.

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