{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:03:23Z","timestamp":1791201803651,"version":"4.2.0"},"reference-count":48,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"\n \n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n To identify incidence and factors associated with sepsis mortality.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We conducted a cohort study of all US publicly insured children younger than age 19 years hospitalized with a diagnosis code\u2013based definition of sepsis in 2021\u20132023 using the Transformed Medicaid Statistical Information System. The outcome was death within 30 days of sepsis onset. Regions were assigned using the Atlas of Pediatric Acute Care. We determined crude mortality and expected death counts by region using a patient-level model including demographics and illness severity. Regional standardized mortality rates (SMRs) were calculated as observed-to-expected ratios. Outlier regions had 95% CIs of SMR not crossing 1. Expected numbers of outlier regions were simulated. We evaluated region-level mortality risk factors using hierarchical models, then determined 30-day rehospitalizations.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n There were 50,668 sepsis episodes with an incidence of 45.1 episodes per 100\u2009000 person-years. Among 40\u2009524 community-acquired sepsis episodes, 1562 (3.9%) died within 30 days. Patient age, complex chronic condition type, and organ dysfunction were associated with mortality. Regional SMRs ranged from 0.00 to 3.82; 14 of 104 regions were low-mortality and 12 of 104 high-mortality outliers, exceeding simulated expectations. Regions with a children\u2019s hospital (adjusted odds ratio [aOR], 0.76; 95% CI, 0.61\u20130.94) and higher sepsis incidence (aOR, 0.91; 95% CI, 0.86\u20130.97 per sepsis episode per 10\u2009000 person-years) were associated with lower mortality. Thirty-day rehospitalizations occurred after 16.7% of sepsis episodes.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n There was substantial regional variation in pediatric sepsis mortality. Regions with a children\u2019s hospital and higher sepsis incidence had lower mortality. There were more high- and low-mortality outliers than expected.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2026-077329","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:03:03Z","timestamp":1789430583000},"source":"Crossref","is-referenced-by-count":0,"title":["National Outcomes of Sepsis in Publicly Insured Children: 2021\u20132023"],"prefix":"10.1542","volume":"158","author":[{"given":"Kenneth A.","family":"Michelson","sequence":"first","affiliation":[{"name":"1Division of Emergency Medicine, Ann & Robert Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Bucholz","sequence":"additional","affiliation":[{"name":"2Section of Cardiology, Department of Pediatrics, University of Colorado and Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Nelson","family":"Sanchez-Pinto","sequence":"additional","affiliation":[{"name":"3Division of Critical Care Medicine, Ann & Robert Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Alpern","sequence":"additional","affiliation":[{"name":"1Division of Emergency Medicine, Ann & Robert Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Remick","sequence":"additional","affiliation":[{"name":"4Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Graves","sequence":"additional","affiliation":[{"name":"5Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Skol","sequence":"additional","affiliation":[{"name":"6Stanley Manne Children\u2019s Research Institute, Ann & Robert Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick D.","family":"McMullen","sequence":"additional","affiliation":[{"name":"6Stanley Manne Children\u2019s Research Institute, Ann & Robert Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Singamsetty","sequence":"additional","affiliation":[{"name":"6Stanley Manne Children\u2019s Research Institute, Ann & Robert Lurie Children\u2019s Hospital, Northwestern University Feinberg School of Medicine, Chicago, 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