Half of children admitted with sepsis were seen in the week before

Design

retrospective observational cohort study using a large US administrative claims database, 2016-2022

Population

6,928 paediatric sepsis hospitalisations in children aged 0-18 with 30 days of continuous enrolment; median age 10 years, 64.3% with a complex chronic condition

Primary outcome

any healthcare encounter in the 7 days before sepsis hospitalisation

Effect

53.5% had a prior encounter (outpatient 33.7%, emergency department 28.2%, inpatient 6.2%); 38.9% of those recorded an infection diagnosis; no difference in ventilation, intensive care use or length of stay

Paediatric sepsis is usually treated as a recognition problem at the moment of presentation. This retrospective analysis of the Merative MarketScan claims database looked earlier, at 6,928 US paediatric sepsis hospitalisations between 2016 and 2022 in children with at least 30 days of continuous insurance enrolment.

Over half — 53.5% — had a healthcare encounter in the seven days before admission: 33.7% an outpatient visit, 28.2% an emergency department visit, 6.2% an inpatient stay. Among those with any prior encounter, 38.9% had an infection-related diagnosis recorded at that visit, so roughly one child in five overall had been assessed for infection in the preceding week. Mechanical ventilation, intensive care use and length of stay did not differ between those with and without a prior encounter.

Claims data cannot say whether those earlier visits missed anything — many will have been appropriate assessments of a child who was not yet septic, and 64.3% of this cohort had a complex chronic condition, a group that attends often for other reasons. The finding that outcomes were no worse in the prior-encounter group argues against a systematic missed-opportunity story. What it does justify is safety-netting: a substantial share of children who go on to need intensive care were in front of a clinician days earlier, and the words used at that visit — what to watch for, when to come back, and to whom — are the intervention available at that moment.

• Give explicit safety-netting at every paediatric fever discharge: what to watch for, when to return, and where
• Document the safety-netting advice, so the next clinician knows what the family was told
• Ask at presentation whether the child has been seen elsewhere in the past week and what changed since
• A child with a complex chronic condition attends often — do not let familiarity flatten the assessment
• Outcomes were no worse in children with a prior encounter, so this is not evidence of systematic missed diagnosis

The statistics, in plain English

These are administrative claims, so an encounter is a billed visit and an 'infection-related diagnosis' is a billing code, neither of which describes what was found or advised. Without a comparison group of children who attended and did not develop sepsis, the 53.5% figure cannot be interpreted as a rate of missed opportunity — children attend healthcare often, and the baseline attendance rate in this insured, largely chronically ill population is not reported. That outcomes did not differ between groups is the most informative comparison in the paper, because it is internal to the cohort.

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