35-Impact of Timing of Acute Neurologic Dysfunction on Outcomes in Pediatric Sepsis
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Pediatrics, Sepsis, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.


Alicia M. Alcamo


Introduction/Hypothesis: Acute neurological dysfunction (ND) in sepsis is associated with risk for poor outcomes but whether the timing of ND onset during sepsis differentially affects this risk is unknown. We hypothesized that children who developed ND after sepsis onset have higher risk of poor outcomes compared to ND at sepsis onset.

Methods: We performed a retrospective study using the SPROUT pediatric sepsis data from 128 sites in 26 countries. ND defined using Proulx criteria (GCS<5 or fixed/dilated pupils). Timing of acute ND was categorized as 1) ND at sepsis onset (day 1), 2) ND after sepsis onset (days 2-7), or 3) no ND. We compared categorical data with Fischer's exact and continuous data with Kruskal-Wallis tests. We used logistic regression to test the association of timing of ND with death or functional disability (worsening POPC/PCPC scores) at hospital discharge.

Results: Among 567 children with sepsis/septic shock, 61 (10.8%) had ND at sepsis onset, 26 (4.6%) had ND after sepsis onset, and 480 (84.6%) had no ND. Age, sex, race, comorbidities, baseline POPC/PCPC scores did not differ between groups (all p>0.05). Median (IQR) PIM3 score was higher in ND at sepsis onset than ND after onset and no ND (14.6 [4.6-25.4] vs 6.2 [4.3-11.1] vs 4.0 [1.8-7.9], p<0.001). CNS infection was more common with ND at sepsis onset than after onset and no ND (16% vs 8% vs 3%, p<0.001). Dysfunction of three or more organs on sepsis presentation was more common in ND at sepsis onset (64%) than ND after sepsis onset (27%) or no ND (22%, p<0.001). Death or functional disability occurred in 74% with ND at sepsis onset, 81% with ND after sepsis onset, and 34% with no ND (p<0.001 between all groups, p=0.59 between ND at vs after sepsis). After controlling for PIM3, CNS infection, and ≥3 organ dysfunction at sepsis presentation, patients with ND at sepsis onset (aOR 2.6, 95%CI 1.3-5.2) and ND after sepsis onset (aOR 8.1, 95%CI 3.0-22.3) had increased death/functional disability compared with no ND (both p<0.01), but the odds were not different by timing of ND (p=0.06).

Conclusions: Children with acute ND during sepsis have a higher rate of death or functional disability at hospital discharge than those with no ND during sepsis, with a suggestion of higher risk of poor outcomes if ND occurred after as compared to at sepsis onset.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Sepsis
Knowledge Level Advanced
Membership Level Select
Tag Monitoring
Tag Scoring Systems
Year 2021
Alicia Alcamo
assistant professor
Children's Hospital of Philadelphia
neurologic dysfunction
pediatric sepsis


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