Opportunity for Improved Menopausal Hormone Therapy Prescribing

# Opportunity for Improved Menopausal Hormone Therapy Prescribing *Published: 2026 Apr 21* National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data. Rhee C(1)(2), Balamuth F(3), Dysart K(3), Miller E(4), Li Z(3), Huang J(3), Gunturi D(3), Ostapenko S(3), Jin R(1), DelloStritto L(1), Guy J(5)(6), Poland R(5), Sands K(5), Bennett TD(7)(8), Scott HF(7), Alpern ER(9), Sanchez-Pinto LN(9), Russell S(8), DeWitt PE(8), Rebull MN(8), Gray C(10), Daniels L(11), Otto S(12), Carter C(12), Cook LJ(13), Tsemberis E(3), Jordan JT(7), Kapes J(11), Tunick R(11), Kadri SS(14), Badesch BL(14), Chen HC(15), Klompas M(1)(2), Weiss SL(16). Author information: (1)Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts. (2)Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. (3)Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children's Hospital of Philadelphia, Philadelphia. (4)Nemours Children's Health, Wilmington, Delaware. (5)HCA Healthcare, Nashville, Tennessee. (6)Thomas F. Frist Jr College of Medicine, Belmont University, Nashville, Tennessee. (7)Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora. (8)Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora. (9)Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, Illinois. (10)Children's Hospital Colorado Research Institute, Aurora. (11)Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. (12)Utah Data Coordinating Center, University of Utah, Salt Lake City. (13)Department of Pediatrics, University of Utah School of Medicine, and Primary Children's Hospital, Salt Lake City. (14)Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland. (15)Qinesca, Waltham, Massachusetts. (16)Nemours Children's Health and Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Erratum in JAMA. 2026 May 18. doi: 10.1001/jama.2026.8941. Comment on JAMA. 2026 Apr 21;335(15):1304-1306. doi: 10.1001/jama.2026.2814. ## 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. DOI: 10.1001/jama.2026.3100 PMCID: PMC13006895 DOI: 10.1001/jama.2026.1891