Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments

Abstract

Objective: Sepsis is one of the most urgent health care issues worldwide.Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour.Methods: A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. Results:We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001).

Knowledge, attitudes and practices towards the diagnosis and management of paediatric sepsis among paediatric physicians and nurses: a cross-sectional study of 21 hospitals in Hubei Province, China

“…8 Although there are published guidelines for the diagnosis and management of paediatric sepsis, several studies have revealed suboptimal adherence to these guidelines. [9][10][11] However, it is important to note that relevant data for China are lacking. Identifying deficiencies in knowledge and practice among paediatric clinicians and nurses in China would facilitate the development and implementation of training programmes to enhance the quality of care given to children and neonates with sepsis.…”

“…The management of sepsis involves initial resuscitation, ventilatory and circulatory support, maintenance of oxygen delivery, antimicrobial therapy and management of end-organ dysfunction 8. Although there are published guidelines for the diagnosis and management of paediatric sepsis, several studies have revealed suboptimal adherence to these guidelines 9–11. However, it is important to note that relevant data for China are lacking.…”