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Introduction: The global burden of pediatric severe sepsis is not well characterized. Understanding sepsis prevalence, therapies used, and outcomes will help identify research priorities and design adequately powered clinical trials. Methods: We performed a point prevalence study with outcome data in 105 PICUs (26 countries, 6 continents). Results are from the first of 5 planned study days. All patients <18 yrs were screened for severe sepsis by 2 criteria: Research (consensus definitions) and Clinical (physician diagnosis). Data are summarized as medians (IQR) and proportions (95% CI). The prevalence of sepsis by each criterion was compared by McNemar's test. Results: Epidemiology: Of 1,244 patients screened, 127 were identified with severe sepsis. Overall prevalence was 10.2% (8.6, 12.0%), but differed by Research (9.2%, 7.6, 10.9) v. Clinical (5.5% 4.3, 6.9) criteria, p<0.001. The most common infection sites were respiratory (39%) and bloodstream (19%). Etiology was 28% bacterial, 21% viral, 9% fungal, and 42% culture-negative. Health care-associated infections accounted for 46% of cases with an identified pathogen. Therapy: At the time of the study, 61% of patients were treated with vasoactive infusions, 48% with corticosteroids, 70% with mechanical ventilation, 13% with renal replacement, 2% with ECMO. There was no difference in therapy by Research v. Clinical criteria. Outcome: PICU mortality for severe sepsis was 21% (14, 30%), PICU length of stay was 14 days (5-25), ventilator-free days were 20 (8-27), 80% had new or progressive multi-organ dysfunction, and 13% of survivors had worsening Pediatric Cerebral Performance Category (PCPC). There were no differences in morbidity or mortality by Research v. Clinical criteria. Conclusions: The global point prevalence of severe sepsis was 10.2%; one-third of these patients had worsened PCPC or died. Severe sepsis was less frequently identified by physicians compared to consensus definitions but groups identified by each criterion received comparable therapies and outcomes were similar.