SESSION TITLE: Pediatric Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Pregnancy-associated severe sepsis (PASS) among teens has not been systematically examined. We performed a trended population-based comparison of severe sepsis between pregnant and non-pregnant teens in Texas.
METHODS: We used the Texas Inpatient Public Use Data File to identify all teen (ages 10-19 years) pregnancy-associated hospitalizations and corresponding age-similar, non-pregnancy-associated female hospitalizations among state residents for the years 2001-2010. ICD-9CM codes for infection plus organ failure (OF) were then used to identify hospitalizations with PASS and severe sepsis not associated with pregnancy (NPSS). The Texas Center for Health Statistics reports of age-specific live births, abortions and fetal deaths, and previously reported population-based, age-specific linkage data on miscarriage were used to estimate the annual total number of pregnancies (TEP). US Census data were used to derive NPSS-related incidence. Epidemiological, demographic, clinical, and outcome characteristics were compared. Descriptive statistics, Mann-Whitney and Chi-square tests were used.
RESULTS: There were 703,487 teen TEP, with 150 and 1379 PASS and NPSS hospitalizations during study period, respectively. Between 2001-2002 and 2009-2010, the incidence of PASS (per 105 TEP) and NPSS (per 105 non-pregnant teens) increased from 10 to 37, and 7 to 10, respectively (p<0.0001 for each). The genital [PASS](63%) vs. respiratory [NPSS] (30%) systems were the most common sites of infection. The key differences between PASS and NPSS were: presence of chronic co-morbidities 19% vs. 55% (p<0.0001); Medicaid 72% vs. 46% (p<0.0001); development of ≥3 OF 17% vs. 32% (p=0.0002); ICU admission 84% vs. 87% (NS); mean (SD) hospital LOS 11.8 (13.6) vs. 22.1 (64.4) days (p<0.0001); hospital mortality 6.7% vs. 17.4% (p=0.001).
CONCLUSIONS: The incidence of teen PASS rose by 370% over the past decade, outpacing NPSS. The risk of severe sepsis among pregnant teens became nearly 4-fold higher than their non-pregnant counterparts, though associated with less severe illness, with lower resource utilization and case fatality. The sources of the observed trends merit further study.
CLINICAL IMPLICATIONS: Teen pregnancy poses higher risk of severe sepsis, requiring extra vigilance for timely diagnosis and effective intervention.
DISCLOSURE: The following authors have nothing to disclose: Lavi Oud, Phillip Watkins, Moss Hampton
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