Tan B, et al. - In this systematic review and meta-analysis of 94 published studies including 7561 patients, researchers investigated the global trends of case-fatality risk in pediatric severe sepsis and septic shock. Outcomes suggest a declining trend of case-fatality rates (CFRs) in pediatric severe sepsis and septic shock, but with persistent significant disparities between developing and developed countries. This study emphasizes the necessity for further characterizations of vulnerable populations and collaborations between developed and developing countries to reduce the burden of pediatric sepsis globally.

• Using the keywords “pediatric,” “sepsis,” “septic shock,” and “mortality”, researchers searched PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central systematically for randomized clinical trials and prospective observational studies from earliest publication until January 2017.
• Studies were included if they involved children with severe sepsis and septic shock and reported CFRs.
• They excluded the retrospective studies and studies including only neonates.
• This systematic review and meta-analysis was performed in close accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
• Using random-effects meta-analysis, they obtained pooled case-fatality estimates.
• With meta-regression, they assessed the associations of study period, study design, sepsis severity, age, and continents in which studies occurred.
• Main outcomes and measures comprised meta-analyses to provide pooled estimates of CFR of pediatric severe sepsis and septic shock over time.

• Researchers included 94 studies that included 7561 patients.
• Higher pooled CFRs were evident in developing countries (31.7% [95% CI, 27.3%-36.4%]) than in developed countries (19.3% [95% CI, 16.4%-22.7%]; P < .001).
• They also noted significant heterogeneity across studies in meta-analysis of CFRs.
• Higher CFRs were reported in continents that include mainly developing countries (adjusted odds ratios: Africa, 7.89 [95% CI, 6.02-10.32]; P < .001; Asia, 3.81 [95% CI, 3.60-4.03]; P < .001; South America, 2.91 [95% CI, 2.71-3.12]; P < .001) when compared to North America.
• Higher CFRs were noted in correlation with septic shock when compared to severe sepsis (adjusted odds ratios, 1.47 [95% CI, 1.41-1.54]).
• In addition, they identified younger age to be a risk factor (adjusted odds ratio, 0.95 [95% CI, 0.94-0.96] per year of increase in age).
• They observed higher CFRs in association with earlier study eras (adjusted odds ratios for 1991-2000, 1.24 [95% CI, 1.13-1.37]; P < .001) compared with 2011 to 2016.
• Developing countries showed higher CFRs over time than developed countries in time-trend analysis .