There has been a downward trend in pediatric severe sepsis and septic shock case-fatality rates between 1981 and 2016, researchers reported in JAMA Pediatrics. However, they found “significant disparities” in cases between developed and developing nations.
“Globally, there is a decreasing mortality risk in children with severe sepsis and septic shock over time,” Jan Hau Lee, MBBS, MRCPCH, MCI, a senior consultant at the pediatric ICU of the KK Women’s and Children’s Hospital and an assistant professor at Duke NUS Medical School in Singapore, told Infectious Diseases in Children. “However, mortality remains higher in certain continents such as Africa, Asia and South America. Efforts to test and implement strategies to improve outcomes of children with severe sepsis and septic shock in these areas are urgently required."
Lee and colleagues conducted a systematic search of PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Central for randomized clinical trials and prospective observational studies published through January 2017 that involved children with severe sepsis and septic shock and reported case-fatality rates (CFRs).
The researchers included 94 studies (n = 7,561). The mean age of the children in the studies was 4.8 years, but children in developing countries had a younger mean age than those in developed countries, the researchers noted.
Lee and colleagues reported that developing countries had higher pooled CFRs (31.7%) compared with developed countries (19.3%). A meta-analysis of CFRs found a significant heterogeneity across the studies. The researchers wrote that Africa, Asia and South America, which include mainly developing countries, reported higher CFRs (adjusted ORs = 7.89, 3.81 and 2.91, respectively) compared with North America.
The researchers wrote that septic shock had an association with higher CFRs compared with severe sepsis. Younger age also was associated with higher CFRs. There were higher pooled CFRs in the early years of the studies (43.1% during 1981 to 1990) compared with later years (22.8% during 2001 to 2016).
“The overall CFRs associated with pediatric severe sepsis and septic shock remains high (25%),” Lee and colleagues concluded. “Efforts to improve medical care in resource-poor settings are needed to decrease the global mortality in pediatric severe sepsis and septic shock.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.