{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:26:30Z","timestamp":1792203990393,"version":"4.4.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,4,21]]},"abstract":"\n Importance<\/jats:title>\n Pediatric sepsis causes substantial morbidity and mortality, but population surveillance relies on administrative codes with limited and variable accuracy.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate US national incidence, mortality, and trends of sepsis in nonneonatal children using a Pediatric Sepsis Event (PSE) definition adapted from the 2024 Phoenix criteria for scalable electronic health record (EHR)\u2013based surveillance using routinely captured clinical data.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Retrospective cohort study of 3.9 million hospitalizations (age, &amp;gt;30 days to 17 years) in 2 EHR datasets: Epic Cosmos (245 health care systems, 2016-2023) and HCA Healthcare (146 hospitals, 2018-2023). Secondary datasets were analyzed to assess feasibility of implementation and face validity across heterogeneous settings. The PSE was validated through medical record reviews of 581 high-risk encounters at 3 geographically diverse hospitals.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n A PSE required presumed infection with concurrent organ dysfunction using Phoenix-derived thresholds adapted for routine EHR data. Septic shock was defined as a PSE with cardiovascular dysfunction.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Sepsis incidence, characteristics, and in-hospital mortality were calculated. Sensitivity and specificity of PSE for physician-adjudicated Phoenix sepsis were compared with administrative codes for severe sepsis\/septic shock. National sepsis case counts and deaths in 2022 and temporal trends from 2016 to 2022 were estimated using regression models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 3\u202f926\u202f809 pediatric hospitalizations from 2016 to 2023, 51\u202f542 sepsis cases (mean age, 6.6 [SD, 6.0] years; 22\u202f840 [44.3%] female) were identified (1.3% incidence); 37\u202f405 (72.6%) were community onset and 31\u202f744 (61.6%) had septic shock. In-hospital mortality was 10.1% and sepsis was present in 17.8% of hospitalizations that culminated in death. Incidence, characteristics, and mortality were broadly consistent across secondary datasets. On medical record review, the PSE definition had 69.9% sensitivity (95% CI, 58.1%-79.8%) and 93.1% specificity (95% CI, 89.6%-95.7%), with higher sensitivity than and comparable specificity with administrative codes. National estimates for 2022 were 18\u202f231 sepsis cases (95% CI, 16\u202f129-20\u202f334) and 1877 deaths(95% CI, 1629-2126). Neither sepsis cases nor deaths changed significantly from 2016 to 2022 (annual change, 0.2% [95% CI, \u22122.2% to 2.7%] and 0.3% [95% CI, \u22123.1% to 3.8%], respectively).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n An EHR-based definition for pediatric sepsis demonstrated strong validity compared with physician-adjudicated Phoenix sepsis and identified sepsis in 1.3% of pediatric hospitalizations with 10% mortality, corresponding to more than 18\u202f000 cases and more than 1800 deaths annually in the US.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.3100","type":"journal-article","created":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T19:30:19Z","timestamp":1774207819000},"page":"1321","source":"Crossref","is-referenced-by-count":12,"title":["National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data"],"prefix":"10.1001","volume":"335","author":[{"given":"Chanu","family":"Rhee","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Balamuth","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children\u2019s Hospital of Philadelphia, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Dysart","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children\u2019s Hospital of Philadelphia, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Miller","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Health, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children\u2019s Hospital of Philadelphia, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children\u2019s Hospital of Philadelphia, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepthi","family":"Gunturi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children\u2019s Hospital of Philadelphia, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Ostapenko","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children\u2019s Hospital of Philadelphia, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"DelloStritto","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Guy","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"},{"name":"Thomas F. 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