Epidemiology of community acquired sepsis in children in Australia and New Zealand: a multicentre prospective cohort study

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Background: Paediatric sepsis epidemiology is unclear due to variability in case ascertainment. We describe the epidemiology of community acquired sepsis in Australian and New Zealand children using the Phoenix sepsis criteria. Methods: Prospective observational study conducted in 11 hospitals through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0-<18 years with suspected sepsis were included. Demographic information, therapies administered, and outcomes were collected, and the Phoenix sepsis criteria were applied. Findings: Of 822,072 children assessed, 6232 (0.8%) children had suspected sepsis and 306 (<0.1%) met the Phoenix sepsis criteria. Children who met the Phoenix sepsis criteria had higher rates of intensive care unit admission (245/306; 80.1% vs 1080/6232; 17.3%), vasoactive infusion (144/306; 47.1% vs 179/6232; 2.9%) mechanical ventilation (146/306; 47.7% vs 251/6232; 4.0%), and extracorporeal life support (12/306; 3.9% vs 13/6232; 0.2%) compared to the overall cohort. Intensive care unit and hospital length of stay were longer for those meeting Phoenix sepsis criteria than for the overall cohort (median 48.4 h vs 79.8 h and 69.7 h vs 189.8 h, respectively). Overall, 87/6232 (1.4%) patients died within 90 days, 42/306 (13.7%) of whom met Phoenix sepsis criteria. Interpretation: Hospitalisation for suspected sepsis was relatively infrequent. The Phoenix sepsis criteria identified children with more severe illness and worse outcomes, but underestimated the overall burden of sepsis. Funding: The National Health and Medical Research Council, the Medical Research Futures Fund, The Royal Children's Hospital Foundation, and the Victorian Government.

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