Sepsis linked to nearly 1 in 5 pediatric hospital deaths in the US
New surveillance approach uses clinical data from electronic health records to track pediatric sepsis across hospitals nationwide
BOSTON, MA — Nearly 1 in 5 pediatric hospital deaths in the United States involve sepsis, according to a new national study published March 22 in JAMA. The study also found that sepsis occurs in about 1 in every 75 pediatric hospitalizations and that more than 1 in 10 children with sepsis die during hospitalization.
Based on these findings, the authors estimate that more than 18,000 hospitalized children in the United States have sepsis each year, including more than 1,800 who do not survive to discharge.
The study, “National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data,” was led by investigators from the SEPSIS Center at the Harvard Pilgrim Health Care Institute, the Children’s Hospital of Philadelphia, and Nemours Children’s Hospital, Delaware, with contributions from multiple collaborating health systems across the country. The research was supported by funding from the Centers for Disease Control and Prevention (CDC).
A New Way to Measure Pediatric Sepsis
Sepsis is a life-threatening condition that occurs when the body’s response to infection causes damage to its own organs. Although sepsis is widely recognized as a leading cause of death in both adults and children, its true burden has historically been difficult to measure reliably.
For many years, researchers relied on hospital billing codes to identify sepsis cases. However, diagnosis and coding practices vary across hospitals and are changing over time, leading to uncertainty about how often sepsis truly occurs.
To address this challenge for children, the research team developed a new surveillance definition called Pediatric Sepsis Event (PSE). The definition builds on the CDC’s Adult Sepsis Event surveillance framework and adapts the recently developed Phoenix pediatric sepsis clinical criteria into a scalable approach that uses objective clinical data from electronic health records—including laboratory results, antibiotics, and markers of organ dysfunction—to generate consistent estimates of pediatric sepsis across hospitals nationwide.
“Improving outcomes starts with measuring the problem accurately,” said Chanu Rhee, MD, MPH, Harvard Medical School associate professor at the Harvard Pilgrim Health Care Institute and one of the two lead authors of the study. “By building a standardized national surveillance framework based on objective clinical data, we can now reliably track how often pediatric sepsis occurs and how many children are affected, creating a stronger foundation for prevention and improvement.”
Key Findings
Researchers analyzed 3.9 million pediatric hospitalizations from 2016 through 2023 across hundreds of hospitals and health systems. The Pediatric Sepsis Event definition was also validated through physician chart review and was found to be more accurate than identifying sepsis using billing codes.
Key findings included:
Why This Matters
The study provides the first standardized national estimates of pediatric sepsis based on clinical data from U.S. hospitals and establishes a scalable framework for tracking pediatric sepsis across health systems.
“Sepsis remains one of the leading causes of serious illness and death among children,” said Scott Weiss, MD, MSCE, division chief of critical care medicine at Nemours Children’s Hospital and one of the two senior authors of the study. “Having a reliable way to measure pediatric sepsis across hospitals using criteria aligned with consensus clinical and research definitions is an essential step toward improving care, guiding prevention and policy efforts, and ultimately saving lives.”
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Based on these findings, the authors estimate that more than 18,000 hospitalized children in the United States have sepsis each year, including more than 1,800 who do not survive to discharge.
The study, “National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data,” was led by investigators from the SEPSIS Center at the Harvard Pilgrim Health Care Institute, the Children’s Hospital of Philadelphia, and Nemours Children’s Hospital, Delaware, with contributions from multiple collaborating health systems across the country. The research was supported by funding from the Centers for Disease Control and Prevention (CDC).
A New Way to Measure Pediatric Sepsis
Sepsis is a life-threatening condition that occurs when the body’s response to infection causes damage to its own organs. Although sepsis is widely recognized as a leading cause of death in both adults and children, its true burden has historically been difficult to measure reliably.
For many years, researchers relied on hospital billing codes to identify sepsis cases. However, diagnosis and coding practices vary across hospitals and are changing over time, leading to uncertainty about how often sepsis truly occurs.
To address this challenge for children, the research team developed a new surveillance definition called Pediatric Sepsis Event (PSE). The definition builds on the CDC’s Adult Sepsis Event surveillance framework and adapts the recently developed Phoenix pediatric sepsis clinical criteria into a scalable approach that uses objective clinical data from electronic health records—including laboratory results, antibiotics, and markers of organ dysfunction—to generate consistent estimates of pediatric sepsis across hospitals nationwide.
“Improving outcomes starts with measuring the problem accurately,” said Chanu Rhee, MD, MPH, Harvard Medical School associate professor at the Harvard Pilgrim Health Care Institute and one of the two lead authors of the study. “By building a standardized national surveillance framework based on objective clinical data, we can now reliably track how often pediatric sepsis occurs and how many children are affected, creating a stronger foundation for prevention and improvement.”
Key Findings
Researchers analyzed 3.9 million pediatric hospitalizations from 2016 through 2023 across hundreds of hospitals and health systems. The Pediatric Sepsis Event definition was also validated through physician chart review and was found to be more accurate than identifying sepsis using billing codes.
Key findings included:
- Sepsis occurred in 1.3% of pediatric hospitalizations (approximately 1 in every 75 hospitalized children)
- More than 1 in 10 children with sepsis died during hospitalization
- Nearly 1 in 5 pediatric hospital deaths involved sepsis
- Rates of pediatric sepsis and associated mortality remained relatively stable nationwide between 2016 and 2022
Why This Matters
The study provides the first standardized national estimates of pediatric sepsis based on clinical data from U.S. hospitals and establishes a scalable framework for tracking pediatric sepsis across health systems.
“Sepsis remains one of the leading causes of serious illness and death among children,” said Scott Weiss, MD, MSCE, division chief of critical care medicine at Nemours Children’s Hospital and one of the two senior authors of the study. “Having a reliable way to measure pediatric sepsis across hospitals using criteria aligned with consensus clinical and research definitions is an essential step toward improving care, guiding prevention and policy efforts, and ultimately saving lives.”
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