To evaluate the proportion of children fulfilling "
Sepsis-3" definition and International Pediatric
Sepsis Consensus Conference definition among children diagnosed to have
septic shock and compare the mortality risk between the two groups.
DESIGN: Retrospective chart review.
SETTING: PICU of a tertiary care teaching hospital from 2014 to 2017.
PATIENTS: None.
MEASUREMENTS AND MAIN RESULTS: We applied both International Pediatric
Sepsis Consensus Conference and the new "
Sepsis-3" definition (
sepsis with
hypotension requiring vasopressors and a
lactate value of ≥ 2 mmol/L) to identify cases of
septic shock by these definitions. Key outcomes such as mortality, proportion attaining
shock reversal at 24 hours and organ dysfunction were compared between those fulfilling "
Sepsis-3" definitions ("
Sepsis-3" group) and those fulfilling "International Pediatric
Sepsis Consensus Conference" definition ("International Pediatric
Sepsis Consensus Conference" group). A total of 216 patients fulfilled International Pediatric
Sepsis Consensus Conference definitions of
septic shock. Of these, only 104 (48%; 95% CI, 42-55) fulfilled "
Sepsis-3" definition. Children fulfilling "
Sepsis-3 plus International Pediatric
Sepsis Consensus Conference definitions" ("
Sepsis-3 and International Pediatric
Sepsis Consensus Conference" group) had lower proportion with
shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62-0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07-1.45) at 24 hours. The mortality was 48.5% in "
Sepsis-3 and International Pediatric
Sepsis Consensus Conference" group as compared with 37.5% in the "International Pediatric
Sepsis Consensus Conference only" group (relative risk, 1.3; 95% CI, 0.94-1.75).
CONCLUSIONS: Less than half of children with
septic shock identified by International Pediatric
Sepsis Consensus Conference definitions were observed to fulfill the criteria for
shock as per "
Sepsis-3" definitions. Lack of difference in the risk of mortality between children who fulfilled "
Sepsis-3" definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of
septic shock in children.