AUTHOR=Zhang Xuepeng , Sun Kaibo , Lu Guoyan , Feng Liwei , Chen Siyuan , Ji Yi 

TITLE=Comparison of PICU Cost and Severity-Adjusted Cost Between Patients With SIRS-Defined Sepsis and Those With Age-Adapted SOFA-Defined Sepsis

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.628918

DOI=10.3389/fped.2021.628918

ISSN=2296-2360

ABSTRACT=<p><bold>Background:</bold> The <italic>2005 International Pediatric Sepsis Consensus</italic> definition is considered to lack specificity and may lead to the admission of low-risk patients to the pediatric intensive care unit (PICU). The aim of this study was to compare the PICU cost and the severity-adjusted cost between patients with sepsis defined by the <italic>2005 International Pediatric Sepsis Consensus</italic> and those diagnosed using the age-adapted Sepsis-3 criteria.</p><p><bold>Methods:</bold> Septic children identified by the <italic>2005 Consensus</italic> were screened for enrollment. The enrolled children were stratified into two subgroups using the age-adapted Sepsis 3.0 definition. A comparison was made between the subgroups of sepsis 3.0-defined children and non-sepsis 3.0-defined septic children. The Severity Adjusted ICU Cost (SAIC) was used to evaluate the case-mixed severity-adjusted costs of the study population. Coefficients in linear regression analyses in subgroups were calculated for presenting variation of PICU costs for every unit change of PRISM score.</p><p><bold>Results:</bold> A total of 397 children were enrolled. The PICU length of stay was longer in the sepsis 3.0 group than in the non-sepsis 3.0 group [median (IQR), 9.0 (5.0, 15.0) vs. 6.0 (3.0, 9.0); <italic>P</italic> &lt; 0.001]. Pediatric risk of mortality (PRISM) scores and mortality were significantly higher in sepsis 3.0-defined septic patients. The total costs and daily costs in the PICU were both significantly lower in the non-sepsis 3.0 group (<italic>P</italic> &lt; 0.001). The severity-adjusted ICU cost in the non-sepsis 3.0 group was lower than that in the sepsis 3.0 group [median (IQR), 7,125 (3,588, 11,134) vs. 9,364 (5,680, 15,876); <italic>P</italic> = 0.001]. There was no significant difference among the regression coefficients.</p><p><bold>Conclusions:</bold> The <italic>2005 International Pediatric Sepsis Consensus</italic> definition does not lead to more PICU costs after considering illness severity.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>, identifier: NCT03598127.</p>