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Research Snapshot Theater: Epidemiology - Outcomes, Pediatric III

Linkage of a Quality Improvement Sepsis Cohort to Health Record Dataset for Target Trial Emulation

Sunday, March 22, 2026
12:15 PM - 1:15 PM Central Time
Location: Connections Central - RST 17
  • JF

    Julie C. Fitzgerald, MD, PhD, MSCE, FCCM

    The Children's Hospital of Philadelphia, Pennsylvania

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SM

    Sahal Master, N/A

    Data Scientist
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • LU

    Levon Utidjian, MD MBI

    Assistant Professor of Pediatrics
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • AK

    Aqsa Khan, N/A

    Data Scientist
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • AC

    Atzael Campos, N/A

    Data Scientist
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • RS

    Ruchi Singh, N/A

    Clinical Research Study Lead
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • AJ

    Aliyah Jones, N/A

    Clinical Research Coordinator
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • GP

    Grace Park, N/A

    Clinical Research Program Manager
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • SB

    Sam Boss, N/A

    Analytics Engineer
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • AG

    Amy Goodwin Davies, N/A

    Analytics Lead
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • Scott L. Weiss, MD, FCCM

    Nemours Childrens Hospital
    Sidney Kimmel Medical Center at Thomas Jefferson University, Pennsylvania

    Disclosure information not submitted.

  • MD

    Michelle Denburg, MD MSCE

    Associate Professor of Pediatrics and Epidemiology
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • FB

    Fran Balamuth, MD PhD MSCE

    Associate Professor of Pediatrics
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

Introduction: Multicenter electronic health record (EHR) databases can facilitate target trial emulation. We evaluated the accuracy of linking a single-center quality improvement (QI) cohort with similar eligibility criteria as a pediatric sepsis randomized trial to a large pediatric EHR database as proof of principle for future multicenter cohort development to emulate this randomized trial.


Methods: Patients aged 2 months – 17 years in a local QI cohort who had confirmed collection of blood culture and receipt of IV fluid bolus and broad-spectrum antibiotic, hereafter called “sepsis treatment”, in the emergency department (ED) followed by inpatient admission between December 2021 and December 2023 (n=1061) were linked to records in the PEDSnet EHR database. Test characteristics were calculated to determine the accuracy of identification of these encounters within all ED encounters resulting in an inpatient admission at this center in PEDSnet in the same time frame (n=26,611). Participants in the PRagMatic Pediatric Trial of Balanced vs. nOrmaL Saline FlUid in Sepsis (PRoMPT BOLUS) interventional trial at this center (n=286) were also linked to PEDSnet records for additional evaluation of the linkage method.


Results: 1061 patients in the QI cohort received sepsis treatment. After initial linkage, evaluation of discrepancies, and refinement of the code defining PEDSnet encounters with sepsis treatment, 1000 (94%) were matched in PEDSnet. Sixty-three were not matched in PEDSnet and an additional 318 patients in PEDSnet received sepsis treatment but were not in the QI cohort. Sensitivity was 94%, specificity 99%, positive predictive value 76%, and negative predictive value >99%, for an accuracy of 99%. Of 286 enrolled trial participants, 260 (91%) were matched in PEDSnet and met the sepsis treatment criteria for target trial emulation cohort inclusion.


Conclusions: Linkage of PEDSnet records with a single-center QI cohort meeting sepsis treatment criteria similar to target trial eligibility criteria showed high accuracy. Evaluation of false positives and negatives improved coding for defining the cohort. Use of these cohort definitions in the multicenter PEDSnet database is anticipated to generate a large cohort emulating the trial population, facilitating accurate real-world target trial emulation analyses.