Pediatric sepsis contributes to significant hospital deaths in the United States

Nearly 1 in 5 pediatric hospital deaths in the United States are caused by sepsis, according to a new national study published March 22. Jama. The study also found that sepsis occurs in 1 in every 75 pediatric hospitalizations and 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 each year have sepsis, including more than 1,800 who do not survive to discharge.

The study, “National Estimate of Pediatric Sepsis in U.S. Hospitals Using Clinical Data,” was led by investigators from Harvard Pilgrim Health Care Institute’s SEPSIS Center, Children’s Hospital of Philadelphia, and Nemours Children’s Hospital of Delaware, with contributions from several 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 damages 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 reliably measure.

For many years, researchers relied on hospital billing codes to identify sepsis cases. However, diagnosis and coding practices vary across hospitals and change over time, creating uncertainty about how often sepsis actually occurs.

To address this challenge for children, the research team developed a new monitoring definition called Pediatric Sepsis Event (PSE). The definition is based on CDC’s adult sepsis event surveillance framework and adapts the recently developed Phoenix pediatric sepsis diagnostic 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 in hospitals across the country.

Improving results starts with measuring the problem accurately. 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.

Chanu Rhee, MD, MPH, associate professor at Harvard Medical School, Harvard Pilgrim Health Care Institute, and one of two lead authors of the study

key findings

Researchers analyzed 3.9 million pediatric hospitalizations across hundreds of hospitals and health systems from 2016 to 2023. The definition of pediatric sepsis incidence was also validated through physician chart review and found to be more accurate than identifying sepsis using billing codes.

Key findings include:

• Sepsis occurred in 1.3% of pediatric hospitalizations (about 1 in every 75 hospitalized children).
• More than 1 in 10 children with sepsis died during hospitalization
• Nearly 1 in 5 pediatric hospital deaths result from sepsis
• Pediatric sepsis and related mortality rates remain relatively stable nationwide between 2016 and 2022

The study also found that most pediatric sepsis cases were present on admission, but a small but notable proportion developed during hospitalization and were associated with higher mortality. These findings highlight the importance of hospitals strengthening early detection and infection prevention efforts.

Why does it matter?

The study provides the first standardized national estimate of pediatric sepsis based on clinical data from US 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 in children,” said Scott Weiss, MD, MSCE, division chief of Critical Care Medicine at Nemours Children’s Hospital and one of the study’s two senior authors. “Having a reliable way to measure pediatric sepsis in hospitals using criteria consistent with consensus clinical and research definitions is an essential step toward improving care, guiding prevention and policy efforts, and ultimately saving lives.”