• Jhuma Sankar, Nitin Dhochak, Kiran Kumar, Man Singh, M Jeeva Sankar, and Rakesh Lodha.
• All authors: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
• Pediatr Crit Care Me. 2019 Mar 1; 20 (3): e122-e129.

ObjectivesTo evaluate the proportion of children fulfilling "Sepsis-3" definition and International Pediatric Sepsis Consensus Conference definition among children diagnosed to have septic shock and compare the mortality risk between the two groups.DesignRetrospective chart review.SettingPICU of a tertiary care teaching hospital from 2014 to 2017.PatientsChildren (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay.InterventionsNone.Measurements And Main ResultsWe applied both International Pediatric Sepsis Consensus Conference and the new "Sepsis-3" definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling "Sepsis-3" definitions ("Sepsis-3" group) and those fulfilling "International Pediatric Sepsis Consensus Conference" definition ("International Pediatric Sepsis Consensus Conference" group). A total of 216 patients fulfilled International Pediatric Sepsis Consensus Conference definitions of septic shock. Of these, only 104 (48%; 95% CI, 42-55) fulfilled "Sepsis-3" definition. Children fulfilling "Sepsis-3 plus International Pediatric Sepsis Consensus Conference definitions" ("Sepsis-3 and International Pediatric Sepsis Consensus Conference" group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62-0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07-1.45) at 24 hours. The mortality was 48.5% in "Sepsis-3 and International Pediatric Sepsis Consensus Conference" group as compared with 37.5% in the "International Pediatric Sepsis Consensus Conference only" group (relative risk, 1.3; 95% CI, 0.94-1.75).ConclusionsLess than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per "Sepsis-3" definitions. Lack of difference in the risk of mortality between children who fulfilled "Sepsis-3" definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children.

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