• Christina Cheung, Kate F Kernan, Robert A Berg, Athena F Zuppa, Daniel A Notterman, Murray M Pollack, David Wessel, Kathleen L Meert, Mark W Hall, Christopher Newth, John C Lin, Allan Doctor, Tom Shanley, Tim Cornell, Rick E Harrison, Russell K Banks, Ron W Reeder, Richard Holubkov, Joseph A Carcillo, Ericka L Fink, and on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
• Division of Pediatric Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
• Pediatr Crit Care Me. 2023 Oct 1; 24 (10): 840848840-848.

ObjectivesAcute disorders of consciousness (DoC) in pediatric severe sepsis are associated with increased risk of morbidity and mortality. We sought to examine the frequency of and factors associated with DoC in children with sepsis-induced organ failure.DesignSecondary analysis of the multicenter Phenotyping Sepsis-Induced Multiple Organ Failure Study (PHENOMS).SettingNine tertiary care PICUs in the United States.PatientsChildren less than 18 years old admitted to a PICU with severe sepsis and at least one organ failure during a PICU stay.InterventionsNone.Measurements And Main ResultsThe primary outcome was frequency of DoC, defined as Glasgow Coma Scale (GCS) less than 12 in the absence of sedatives during an ICU stay, among children with severe sepsis and the following: single organ failure, nonphenotypeable multiple organ failure (MOF), MOF with one of the PHENOMS phenotypes (immunoparalysis-associated MOF [IPMOF], sequential liver failure-associated MOF, thrombocytopenia-associated MOF), or MOF with multiple phenotypes. A multivariable logistic regression analysis was performed to evaluate the association between clinical variables and organ failure groups with DoC. Of 401 children studied, 71 (18%) presented with DoC. Children presenting with DoC were older (median 8 vs 5 yr; p = 0.023), had increased hospital mortality (21% vs 10%; p = 0.011), and more frequently presented with both any MOF (93% vs 71%; p < 0.001) and macrophage activation syndrome (14% vs 4%; p = 0.004). Among children with any MOF, those presenting with DoC most frequently had nonphenotypeable MOF and IPMOF (52% and 34%, respectively). In the multivariable analysis, older age (odds ratio, 1.07; 95% CI, 1.01-1.12) and any MOF (3.22 [1.19-8.70]) were associated with DoC.ConclusionsOne of every five children with severe sepsis and organ failure experienced acute DoC during their PICU stay. Preliminary findings suggest the need for prospective evaluation of DoC in children with sepsis and MOF.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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