Original Investigation 

Caring for the Critically Ill Patient

National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data

Chanu Rhee, Fran Balamuth, Kevin Dysart, et al

JAMA Published Online: March 22, 2026

doi: 10.1001/jama.2026.3100

Key Points

Question  What is the burden of nonneonatal pediatric sepsis in US hospitals using an electronic health record–based surveillance definition aligned with the 2024 Phoenix criteria?

Findings  In this retrospective cohort study of more than 3.9 million pediatric hospitalizations, a Pediatric Sepsis Event (PSE) definition identified sepsis in 1.3% of encounters with 10.1% in-hospital mortality and in 17.8% of hospitalizations that culminated in death, corresponding to more than 18 000 US cases and more than 1800 deaths annually. Neither sepsis cases nor deaths changed significantly from 2016 to 2022.

Meaning  The PSE criteria provide a standardized, scalable framework for pediatric sepsis surveillance and underscore its substantial burden among hospitalized US children.

Abstract

Importance  Pediatric sepsis causes substantial morbidity and mortality, but population surveillance relies on administrative codes with limited and variable accuracy.

Objective  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)–based surveillance using routinely captured clinical data.

Design, Setting, and Participants  Retrospective cohort study of 3.9 million hospitalizations (age, >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.

Exposures  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.

Main Outcomes and Measures  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.

Results  Among 3 925 809 pediatric hospitalizations from 2016 to 2023, 51 542 sepsis cases (mean age, 6.6 [SD, 6.0] years; 22 840 [44.3%] female) were identified (1.3% incidence); 37 405 (72.6%) were community onset and 31 744 (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 18 231 sepsis cases (95% CI, 16 129-20 334) and 1877 deaths(95% CI, 1629-2126). Neither sepsis cases nor deaths changed significantly from 2016 to 2022 (annual change, 0.2% [95% CI, −2.2% to 2.7%] and 0.3% [95% CI, −3.1% to 3.8%], respectively).

Conclusions and Relevance  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 18 000 cases and more than 1800 deaths annually in the US.