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Overall, mortality following pediatric shock has declined dramatically over the
past several decades with improved recognition and implementation of goaldirected resuscitation protocols. Recent estimates suggest mortality rates between
3% and 6% for pediatric patients presenting to an ED with shock from all
etiologies. The World Health Organization reports that hypovolemic shock due to
diarrhea accounts for 760,000 deaths in children less than 5 years each year. In
the United States, estimates of in-hospital mortality following pediatric septic
shock range from 4.2% to ∼20% depending on the patient population and how
the diagnosis of sepsis is determined (e.g., billing codes vs. chart review). Infants
<1 year, bone marrow transplant recipients, and those with shock-associated
MODS have the highest risk of death following sepsis. Mortality following
hemorrhagic shock due to trauma is estimated at 16%, but these data are largely
from injuries in combat areas and mortality varies substantially depending on the
cause of hemorrhage.
There is increasing emphasis on long-term outcomes, including quality of life
(QOL), following shock because increasing data support that cognitive,
emotional, social, and physical morbidities can persist for weeks or months
following shock resolution. For example, a recent study demonstrated a decrease
in health care QOL scores in 24% of children in the weeks following ICU
admission for community-acquired sepsis. The Life After Pediatric Sepsis
Evaluation (LAPSE) study will determine long-term health-related QOL changes
following sepsis, but data following nonseptic causes of shock are lacking.
CLINICAL PEARLS AND PITFALLS