Corticosteroid use in children with community acquired sepsis: a multicentre prospective cohort study

Objectives Corticosteroids in paediatric sepsis have the potential to improve outcomes, yet there is little supporting evidence regarding efficacy, choice of agents, dose or timing of administration. We describe the patterns of corticosteroid use in children hospitalised with suspected community-acquired sepsis. Design This observational study used data from the multicentre multicountry Sepsis Epidemiology in Australian and New Zealand Emergency Departments study, collected from 2021 to 2023. Patients Participants were children aged 0 to <18 years with suspected sepsis admitted to the hospital through 11 emergency departments in Australia and New Zealand. Main outcome measures We report agent, dose and factors associated with administration for any corticosteroid administered within the first 24 hours of hospitalisation. Results 5119 children had suspected sepsis with a median age of 1.6 years and in-hospital mortality of 1.0% (52/5119). The Phoenix sepsis criteria were met by 4.9% (252/5119) with mortality of 12.7% (32/252). Corticosteroids were used in 9.6% (489/5119) children overall and in 31.3% (79/252) meeting Phoenix sepsis criteria. The most commonly used corticosteroid was dexamethasone (69.5%, 340/489), followed by hydrocortisone (25.4%, 124/489) with considerable variation in preferences overall and between study sites. Factors that were associated with corticosteroid use were: older age, more than one comorbidity, elevated initial lactate, large volume fluid resuscitation and any vasopressor use. Conclusions Children with suspected community acquired sepsis frequently received treatment with corticosteroids. Dexamethasone and hydrocortisone were the most used agents, with the vast majority used outside of the setting of fluid or catecholamine-refractory shock. Trial registration number ACTRN12621000920897.