A quarter of children with severe sepsis die in hospital, finds the largest international study to date.

The SPROUT study of nearly 7,000 critically ill children across 128 centres and 26 sites including Australia revealed a sepsis prevalence of 8.2%, a figure ‘remarkably similar’  to adult populations, the authors said.

“These results suggest that a typical 16-bed PICU is likely to be treating at least one critically ill child for severe sepsis at any given time,” the international team of researchers wrote in the American Journal of Respiratory and Critical Care Medicine.

The hospital mortality of 25% was higher than previously estimated and did not differ by age or between developed or resource limited countries, reported the authors.

The most common sites of infection were respiratory (40%) and blood stream (19%) and common treatments included mechanical ventilation (74%) vasoactive infusions (55%) and corticosteroids (45%).

Speaking to the limbic one of the authors paediatric intensivist Simon Erickson from the Princess Margaret Hospital for Children in Perth said that while it was surprising that mortality rates were not significantly less in developed countries it was probably more a reflection of standards in intensive care units in developing countries. 

“A lot of these countries may only have one or two intensive care units but the standard is pretty good,” he said.

However, mortality rates were probably higher in developing countries as the current study only looked at mortality in ICUs.

“If you looked at general mortality from sepsis in the community it would be higher as a lot of people cannot get access to intensive care,” he said.  

“To conduct international trials in paediatric severe sepsis, we estimate that it would take three years and at least 58 PICUS to enroll 2,118 children aiming for a pragmatic 5% reduction in all-cause PICU mortality,” they wrote.

“Although such a large study may seem ambitious in paediatric severe sepsis we believe that well-designed trials of this magnitude could – and should – be undertaken ,” they concluded.