Paediatric sepsis mortality varied up to several-fold between US regions

Design

National retrospective cohort using Medicaid claims (T-MSIS)

Population

Publicly insured US children under 19 hospitalised with sepsis, 2021–2023 (36,552 episodes)

Primary outcome

30-day mortality after sepsis onset; regional standardised mortality

Effect

Mortality 3.9%; children's hospital region aOR 0.76 (95% CI 0.61–0.94)

This national cohort used US Medicaid data to identify all publicly insured children hospitalised with sepsis in 2021–2023: 36,552 episodes, an incidence of 45.1 per 100,000 person-years.

Thirty-day mortality after community-acquired sepsis was 3.9%. Age, type of complex chronic condition and organ dysfunction predicted death. After adjustment, 12 of 104 regions had higher-than-expected mortality and 14 lower — more outliers than chance would produce. Regions with a children's hospital (adjusted OR 0.76) and those treating more sepsis cases had lower mortality. One in six children was readmitted within 30 days.

This is US administrative data with code-based definitions, but the pattern — better outcomes where paediatric expertise and volume are concentrated — is familiar. It supports clear pathways for early recognition and transfer where local paediatric critical care is limited.

• Use a structured sepsis screening tool for febrile children in emergency and ward settings.
• Agree transfer and retrieval pathways with a paediatric intensive care centre in advance.
• Children with complex chronic conditions carry the highest risk — lower the threshold for escalation.
• Plan follow-up after discharge; one in six children was readmitted within 30 days.

Why it matters

It shows that outcomes, not only incidence, differ by system — pointing to organisation of care as something clinicians can change.

Don't overread it

Administrative coding data and US insurance structures; the regional effect sizes will not transfer directly to other health systems.

The statistics, in plain English

An adjusted odds ratio of 0.76 means about 24% lower odds of death in regions with a children's hospital, after accounting for how ill children were — but unmeasured differences between regions may remain.

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