Table 1.
Characteristics of pediatric patients admitted with severe sepsis/septic shock stratified by potentially missed diagnosis of sepsis in an emergency department visit within 7 days before inpatient admission (patient-level unadjusted analysis)
| Characteristic | Overall | Unlikely missed sepsis in EDa | Potentially missed sepsis in ED | p valueb |
|---|---|---|---|---|
| n = 1,945 | n = 1,787 | n = 158 | ||
| Patient Characteristics | ||||
| Sex, female (%) | 910 (47.1) | 831 (46.8) | 79 (50.6) | 0.352 |
| Age, years, mean (95% CI) | 8.2 (7.9, 8.5) | 8.2 (7.9, 8.5) | 8.4 (7.4, 9.3) | 0.680 |
| Age categories, years (%) | ||||
| Less than 1 | 430 (22.1) | 411 (23.0) | 19 (12.0) | 0.005 |
| 1–4 | 310 (15.9) | 276 (15.4) | 34 (21.5) | |
| 5–9 | 298 (15.3) | 265 (14.8) | 33 (20.9) | |
| 10–14 | 397 (20.4) | 364 (20.4) | 33 (20.9) | |
| 15 or more | 510 (26.2) | 471 (26.4) | 39 (24.6) | |
| Race/ethnicity (%) | ||||
| White | 651 (35.2) | 604 (35.6) | 47 (31.3) | 0.460 |
| Black | 330 (17.9) | 301 (17.7) | 29 (19.3) | |
| Hispanic | 599 (32.4) | 548 (32.3) | 51 (34.0) | |
| Asian/Pacific Islander | 106 (5.7) | 94 (5.5) | 12 (8.0) | |
| Native American | 6 (0.3) | 5 (0.3) | 1 (0.7) | |
| Other | 156 (8.4) | 146 (8.6) | 10 (6.7) | |
| Payer (%) | ||||
| Medicaid | 1,117 (57.4) | 1,032 (57.8) | 85 (53.8) | 0.515 |
| Private insurance | 669 (34.4) | 605 (33.9) | 64 (40.5) | |
| Uninsured | 42 (2.2) | 40 (2.2) | 2 (1.3) | |
| Other | 117 (6.0) | 110 (6.2) | 7 (4.4) | |
| Number of comorbid chronic conditions, mean (95% CI) | 3.7 (3.6, 3.9) | 3.8 (3.7, 3.9) | 3.0 (2.6, 3.4) | <0.001 |
| Weekend admission (%) | 507 (26.1) | 456 (25.5) | 51 (32.3) | 0.064 |
| Hospital Characteristicsc | ||||
| State (%) | ||||
| California | 757 (38.9) | 687 (38.4) | 70 (44.3) | 0.001 |
| New York | 783 (40.3) | 742 (41.5) | 41 (26.0) | |
| Massachusetts | 103 (5.3) | 90 (5.0) | 13 (8.2) | |
| Florida | 302 (15.5) | 268 (15.0) | 34 (21.5) | |
| Type of hospital ownership | ||||
| Public | 315 (16.4) | 286 (16.2) | 29 (18.7) | <0.001 |
| Private, non-profit | 1,517 (79.0) | 1,409 (79.8) | 108 (69.7) | |
| Private, for-profit | 89 (4.6) | 71 (4.0) | 18 (11.6) | |
| Children’s hospital (%) | 309 (17.3) | 300 (18.2) | 9 (6.7) | 0.001 |
| Teaching hospital (%) | 1,550 (80.7) | 1,472 (83.4) | 78 (50.3) | <0.001 |
| Has fully implemented electronic records (%) | 805 (50.7) | 744 (50.1) | 61 (59.8) | 0.159 |
| Has a pediatric ED (%) | 1,286 (72.2) | 1,220 (74.0) | 66 (49.3) | <0.001 |
| Has a pediatric ICU (%) | 1,451 (81.4) | 1,392 (84.5) | 59 (44.0) | <0.001 |
| ED volume (total number of ED visits in a year), median (IQR) | 72,386 (56906, 121686) | 73,747 (57499, 124858) | 57,499 (34511, 95617) | <0.001 |
| ED volume categories (%) | ||||
| <20,000 | 137 (7.1) | 116 (6.6) | 21 (13.6) | <0.001 |
| 20,000–60,000 | 581 (30.2) | 517 (29.3) | 64 (41.3) | |
| 60,001–100,000 | 597 (31.1) | 559 (31.7) | 38 (24.5) | |
| >100,000 | 606 (31.6) | 574 (32.5) | 32 (20.7) |
CI - confidence interval, ED - emergency department, ICU - intensive care unit, IQR - interquartile range,
This group includes patients categorized by an expert panel as unlikely missed sepsis in a prior ED visit and patients without any identified ED visits 7 days before inpatient sepsis admission.
Unlikely missed sepsis vs. potentially missed sepsis groups were compared using Student’s t-test or Wilcoxon rank-sum test for continuous variables and Chi-square test or Fisher’s exact test for categorical variables (unadjusted analysis).
Hospital characteristics are those of the institution diagnosing the patient upon presentation with sepsis (whether correctly diagnosed or potentially missed).