Evidence map›Paper›PMID 27124566›Full record

Observational studyPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2016

Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs.

John S Giuliano, Barry P Markovitz, Joe Brierley, Richard Levin, Gary Williams, Lucy Chai See Lum, Tavey Dorofaeff, Pablo Cruces, Jenny L Bush, Luke Keele and 5 more

Abstract readComparative StudyMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Article
  2. Review
  3. Bundle Adherence of Intravenous Antibiotic Fluid Resuscitation and Vasopressor in Children with Severe Sepsis or Septic Shock.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2020
    Article
  4. Article
  5. International Survey of Critically Ill Children With Acute Neurologic Insults: The Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment Study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2017
    Observational
  6. Update on pediatric sepsis: a review.Journal of intensive care · 2017
    Review
  7. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

John S Giuliano1Division of Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 2Division of Pediatric Critical Care, Departments of Pediatrics and Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA. 3Department of Critical Care and Bioethics, Great Ormond Street Hospital NHS Trust, London, United Kingdom. 4Department of Pediatrics, Royal Hospital for Children, Glasgow, Scotland. 5Intensive Care Department, Sydney Children's Hospital, Randwick, NSW, Australia. 6Department of Pediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia. 7Paediatric Intensive Care Unit, Division of Paediatric Critical Care, Department of Pediatrics, Lady Cilento Children's Hospital, Brisbane, QLD, Australia. 8Department of Pediatric Intensive Care, Hospital El Carmen de Maipu, Universidad Andres Bello, Santiago, Chile. 9Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 10Department of Political Science, Penn State University, University Park, PA. 11Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Penn State University College of Medicine, Hershey, PA.
Barry P Markovitz
Joe Brierley
Richard Levin
Gary Williams
Lucy Chai See Lum
Tavey Dorofaeff
Pablo Cruces
Jenny L Bush
Luke Keele
Vinay M Nadkarni
Neal J Thomas
Julie C Fitzgerald
Scott L Weiss
Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

Funding

Pediatric Critical Care Scientist Development ProgramK12HD047349 · NICHD · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI HEATHER T. KEENAN, Kevin M Watt · 2004 to 2026
$17.0M
Mitochondrial Dysfunction in Pediatric SepsisK23GM110496 · NIGMS · CHILDREN'S HOSP OF PHILADELPHIA · PI WEISS, SCOTT L · 2015 to 2018
$723k
Department of HealthNICHD NIH HHS K12 HD047349NIGMS NIH HHS K23 GM110496Wellcome Trust
6 · The paper itself

Abstract

objectivesPediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies.

designWe conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality.

settingEuropean and U.S. PICUs. PATIENTS: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study.

interventionsNone. MEASUREMENTS AND MAIN

resultsEuropean PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days.

conclusionsChildren with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.

Indexed as

Critical CareSepsisSeverity of Illness IndexAdolescentChildChild, PreschoolCross-Sectional StudiesEuropeFemaleHealthcare DisparitiesHealth Status DisparitiesHospital MortalityHumansInfantInfant, NewbornIntensive Care Units, Pediatric

Identifiers

PMID27124566
PMCPMC5399539

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.