Access to and delivery of emergency sepsis care for high-risk age groups
Creators: name: Swanson, Morgan B
Publisher: name: University of Iowa
Year: 2025
Subjects: Emergency Care
Sepsis
public abstract
Pediatrics

description: Sepsis affects over 50,000 U.S. children and 1.7 million U.S. adults each year, resulting in long-term functional disability and a high risk of mortality. Early recognition and resuscitation of sepsis can reduce mortality and improve outcomes. However, current adherence to early resuscitation guidelines remains low among pediatric and adult sepsis and septic shock patients. This dissertation investigates early sepsis care in two populations: pediatrics (0-18 years) and older adults (65 years and older).
description: Adherence to pediatric sepsis care guidelines is lower than in the adult sepsis population, especially in low-volume facilities. Compared to adults, pediatric sepsis patients may be at higher risk of disparate incidence and outcomes given sparser access to definitive pediatric hospital care. The first two aims of this dissertation use multi-state all-payer administrative claims data and a national readiness survey of emergency departments (EDs) to: (1) identify facility-level characteristics associated with effective pediatric sepsis care and (2) determine the role of distance to care in pediatric sepsis outcomes. In Aim 1, there was no association between ED pediatric readiness and hospital-free days (a composite measure of death, length-of-stay, and readmission) among pediatric sepsis patients. Lower pediatric readiness is, however, associated with increased odds of transfer. In Aim 2, there was also no association between geographic proximity to care (i.e., distance) and hospital-free days in pediatric sepsis patients. Taken together, these findings suggest the current sepsis care system may deliver adequate early sepsis care and utilize transfer to triage patients to the appropriate level of definitive care decreasing the barriers of greater distance and lower pediatric readiness. This is unique from other pediatric emergency conditions, such as trauma, where shorter distance to care and higher pediatric readiness are associated with improved outcomes.
description: In the final aim, national Medicare claims data is leveraged to investigate the sepsis transfer networks of older adults with severe sepsis and septic shock. Currently, there are not universal transfer protocols or guidelines, and there are not national sepsis regionalization networks. Therefore, understanding the actual and potential transfer patterns of sepsis patients can help both elucidate current practice and identify potential next steps for creating a more universal system. In Aim 3, a high degree of exclusivity is noted, as the majority of sepsis hospitals were transferring patients to one to two receiving hospitals. Predictors of sepsis receiving hospitals, including increased ICU capabilities and lower distance, are identified. Further, a paradoxical relationship of worse sepsis care metrics (i.e., lower SEP-1 score and higher hospital adjusted mortality) are associated with greater odds of being a sepsis receiving hospital. These findings illustrate that the sepsis care networks have potential for optimization to improve sepsis outcomes in transferred patients by creating standardized systems to determine sepsis care.
description: Overall, this dissertation uses three studies to better understand the current sepsis regionalized systems of care for children and older adults. It highlights the importance of transfer as an intervention to bring sepsis patients to definitive care and suggests that, in pediatrics, the majority of initial hospital destinations may be able to provide adequate early sepsis care. Further, it highlights an opportunity for future study to develop sepsis transfer systems that may further improve patient outcomes.