CORRESPONDENCE Although we did not report it in the article, when we examined pediatric and adult groups separately, there were no differences between the intervention and control groups with regard to the primary outcomes. We had substantially more females than males in our sample because parents, predominantly mothers, were the respondents for the pediatric group. We do not believe that our attrition rate contributed to the finding of no difference between the groups. Although we had several participants who did not complete the study, nearly 80% did. The study was powered to detect a difference even with this degree of loss to follow up. We used intention-to-treat analysis, and there was no difference. We believe that the initiation of subspecialty care, including the asthma teaching that occurred in both groups during their visits and the medical care that was provided, led to a reduction in asthma morbidity in both groups and may have blunted any effects that the written asthma action plan might have had. We agree with Dr. Anand and colleagues’ conclusion. Our results confirmed that high-risk populations with poor asthma control may experience sustained and substantial reductions in symptom frequency and emergency care and improvement in asthma quality of life in subspecialty care and that the written asthma action plan may not be needed. n Author disclosures are available with the text of this letter at www.atsjournals.org. Beverley J. Sheares, M.D., M.S. David Evans, Ph.D. Columbia University New York, New York
ORCID ID: 0000-0001-6138-0033 (B.J.S.).
References 1. Sheares BJ, Mellins RB, Dimango E, Serebrisky D, Zhang Y, Bye MR, Dovey ME, Nachman S, Hutchinson V, Evans D. Do patients of subspecialist physicians benefit from written asthma action plans? Am J Respir Crit Care Med 2015;191:1374–1383. 2. Backer V, Nepper-Christensen S, Nolte H. Quality of care in patients with asthma and rhinitis treated by respiratory specialists and primary care physicians: a 3-year randomized and prospective follow-up study. Ann Allergy Asthma Immunol 2006;97:490–496. 3. Diette GB, Skinner EA, Nguyen TT, Markson L, Clark BD, Wu AW. Comparison of quality of care by specialist and generalist physicians as usual source of asthma care for children. Pediatrics 2001;108:432–437. 4. Erickson S, Tolstykh I, Selby JV, Mendoza G, Iribarren C, Eisner MD. The impact of allergy and pulmonary specialist care on emergency asthma utilization in a large managed care organization. Health Serv Res 2005; 40:1443–1465.
Copyright © 2016 by the American Thoracic Society
Correspondence
Erratum: Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study There are errors in the article by Weiss and colleagues (1), which appeared in the May 15, 2015, issue of the Journal. The authors detected inaccuracies resulting from a miscoding error in their original analysis. Patients for whom the resolution of one organ system dysfunction coincided with the development of a new dysfunction in a separate organ system were incorrectly coded as having multiorgan dysfunction syndrome (MODS); these patients should have been classified as having new or progressive MODS (NPMODS). The article incorrectly states the number and percentage of patients with MODS on the day of severe sepsis recognition as being 380 (67%); the correct figure is 327 (58%). The incorrect number and percentage of patients with NPMODS was listed as 171 (30%); the correct figure is 228 (40%). The correction in coding did not change the number of organ dysfunctions. These incorrect figures appear in the MEASUREMENTS AND MAIN RESULTS in the abstract; in addition, the last sentence in that paragraph should list the estimated sample sizes needed to detect a 5–10% absolute risk reduction in outcomes within interventional trials as being between 165 and 1,471 (not 1,437). The percentage of MODS and NPMODS patients is also misstated in the paragraph beginning in the middle column on page 1152; in addition, the paragraph on that page before the DISCUSSION section should read: “Assuming a 50% consent rate, between 165 and 1,471 [not 1,437] patients per group would need to be enrolled across 9–81 [not 79] PICUs. . . .” Finally, errors appear in Table 4 and Table E5 in the online supplement; both tables are reprinted below; the corrected figures appear in boldface. The authors have reviewed all of their statistical analyses and believe that the coding error does not alter any of the statistical comparisons or conclusions in the article. They apologize for the inconvenience to the readers. n
Reference 1. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, JaramilloBustamante JC, Salloo A, Singhi SC, Erickson S, Roy JA, Bush JL, et al.; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the Sepsis Prevalence, Outcomes, and Therapies study. Am J Respir Crit Care Med 2015;191:1147–1157.
Copyright © 2016 by the American Thoracic Society
223
CORRESPONDENCE Table 4. Outcomes for Total Cohort and by Age Category
Total Vasoactive-free days, median (IQR) Ventilator-free days, median (IQR) New or progressive MODS† PICU mortality Hospital mortality At least mild disability‡ At least moderate disabilityx Death or disabilityjj
0–28 d
23 (12–28) 20 (5–26) 16 (0–25) 228 139 145 116 73 218
(40) (24) (25) (28) (17) (38)
14 (0–23) 14 9 9 8 5 14
(40) (26) (26) (31) (19) (40)
Age Categories 29 d to
ORCID ID: 0000-0001-6138-0033 (B.J.S.).
References 1. Sheares BJ, Mellins RB, Dimango E, Serebrisky D, Zhang Y, Bye MR, Dovey ME, Nachman S, Hutchinson V, Evans D. Do patients of subspecialist physicians benefit from written asthma action plans? Am J Respir Crit Care Med 2015;191:1374–1383. 2. Backer V, Nepper-Christensen S, Nolte H. Quality of care in patients with asthma and rhinitis treated by respiratory specialists and primary care physicians: a 3-year randomized and prospective follow-up study. Ann Allergy Asthma Immunol 2006;97:490–496. 3. Diette GB, Skinner EA, Nguyen TT, Markson L, Clark BD, Wu AW. Comparison of quality of care by specialist and generalist physicians as usual source of asthma care for children. Pediatrics 2001;108:432–437. 4. Erickson S, Tolstykh I, Selby JV, Mendoza G, Iribarren C, Eisner MD. The impact of allergy and pulmonary specialist care on emergency asthma utilization in a large managed care organization. Health Serv Res 2005; 40:1443–1465.
Copyright © 2016 by the American Thoracic Society
Correspondence
Erratum: Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study There are errors in the article by Weiss and colleagues (1), which appeared in the May 15, 2015, issue of the Journal. The authors detected inaccuracies resulting from a miscoding error in their original analysis. Patients for whom the resolution of one organ system dysfunction coincided with the development of a new dysfunction in a separate organ system were incorrectly coded as having multiorgan dysfunction syndrome (MODS); these patients should have been classified as having new or progressive MODS (NPMODS). The article incorrectly states the number and percentage of patients with MODS on the day of severe sepsis recognition as being 380 (67%); the correct figure is 327 (58%). The incorrect number and percentage of patients with NPMODS was listed as 171 (30%); the correct figure is 228 (40%). The correction in coding did not change the number of organ dysfunctions. These incorrect figures appear in the MEASUREMENTS AND MAIN RESULTS in the abstract; in addition, the last sentence in that paragraph should list the estimated sample sizes needed to detect a 5–10% absolute risk reduction in outcomes within interventional trials as being between 165 and 1,471 (not 1,437). The percentage of MODS and NPMODS patients is also misstated in the paragraph beginning in the middle column on page 1152; in addition, the paragraph on that page before the DISCUSSION section should read: “Assuming a 50% consent rate, between 165 and 1,471 [not 1,437] patients per group would need to be enrolled across 9–81 [not 79] PICUs. . . .” Finally, errors appear in Table 4 and Table E5 in the online supplement; both tables are reprinted below; the corrected figures appear in boldface. The authors have reviewed all of their statistical analyses and believe that the coding error does not alter any of the statistical comparisons or conclusions in the article. They apologize for the inconvenience to the readers. n
Reference 1. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, JaramilloBustamante JC, Salloo A, Singhi SC, Erickson S, Roy JA, Bush JL, et al.; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the Sepsis Prevalence, Outcomes, and Therapies study. Am J Respir Crit Care Med 2015;191:1147–1157.
Copyright © 2016 by the American Thoracic Society
223
CORRESPONDENCE Table 4. Outcomes for Total Cohort and by Age Category
Total Vasoactive-free days, median (IQR) Ventilator-free days, median (IQR) New or progressive MODS† PICU mortality Hospital mortality At least mild disability‡ At least moderate disabilityx Death or disabilityjj
0–28 d
23 (12–28) 20 (5–26) 16 (0–25) 228 139 145 116 73 218
(40) (24) (25) (28) (17) (38)
14 (0–23) 14 9 9 8 5 14
(40) (26) (26) (31) (19) (40)
Age Categories 29 d to
