Prediction of pediatric sepsis mortality within 1 h of intensive care admission

Schlapbach, Luregn J.; MacLaren, Graeme; Festa, Marino S.; Alexander, Janet; Erickson, Simon; Beca, John; Slater, Anthony; Schibler, Andreas; Pilcher, David; Millar, Johnny; Straney, Lahn

doi:10.1007/s00134-017-4701-8

Cited by 140 publications

(109 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Mortality from septic shock remains high worldwide and is in uenced by the time of recognition and initiation of goal directed management [1,2,[10][11][12]. Mortality remains high in the initial 72 hours of onset of sepsis and septic shock partly due to the hyper in ammatory phase (cytokine storm) of the immune response [13].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal Survey

Vekaria-Hirani

Kumar

Musoke

et al. 2019

International Journal of Pediatrics

View full text Add to dashboard Cite

Background. Paediatric septic shock is a subset of sepsis associated with high mortality. Implementing the existing international Surviving Sepsis Campaign Guidelines 2012 (SSCG) have contributed to reduction of mortality in many places but these have not been adopted in our setting. The current study aimed at documenting the practice at a national referral hospital. Methods. A hospital based longitudinal survey carried out among 325 children from September to October 2016. Children aged 0 days (≥37 weeks gestation) to12 years were included. The aim was to determine the prevalence, audit the management and determine the outcome at 72 hours of septic shock among children admitted at the Kenyatta National Hospital (KNH). A standard questionnaire was used for data collection and Surviving Sepsis Guideline 2012 was used as a reference for auditing the management of septic shock. Data was stored in MS-EXCEL and analysed in STATA 12. Results. The prevalence of septic shock was 50 (15.4%), with a median age of 4 months. Septic shock was recognized by the attending clinician in 28 (56%). The level of care to children with septic shock was not to the level recommended by the SSCG 2012. Odds of being diagnosed with septic shock reduced with age (odds ratio 4.38 (1.7–11.0), p=0.002) and no child aged above 60 months age was diagnosed with septic shock. The mortality was 35 (70%) at 72 hours of admission, with a median of 14 hours. Infants had the highest case fatality of 82.6%. It was found that lack of mechanical ventilation, and presence of hypotension at admission were associated with greater mortality (p values of 0.03 and 0.01 respectively). Conclusion. The prevalence rate of septic shock is 15.4% among children admitted at the KNH and is associated with high mortality. The advanced degree of shock contributed to mortality. The level of care at KNH was not to the level of SSCG 2012, and hence the need to include septic shock management guidelines/protocols in our local Kenyan paediatric guideline.

show abstract

Section: Introductionmentioning

confidence: 99%

Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal Survey

Vekaria-Hirani

Kumar

Musoke

et al. 2019

International Journal of Pediatrics

View full text Add to dashboard Cite

show abstract

“…Most patients met the International Pediatric Sepsis Consensus Conference criteria in our study, approximately half met severe sepsis criteria, and one out of four met septic shock criteria. Increased lactate, a marker for mortality in sepsis, was observed in a substantial proportion of cases (70%) . Schuffenecker et al .…”

Section: Discussionmentioning

confidence: 99%

“…Sepsis represents a frequent reason for children requiring admission to paediatric intensive care units (PICUs) and is associated with substantial mortality and morbidity. Many children with sepsis have no bacterial pathogen identified; in some of these children, sepsis will have been triggered by a viral infection …”

Section: Literature Review On Previously Published Reports On Human Pmentioning

confidence: 99%

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

McKenna

Joseph

Sargent

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

Aim: The human parechovirus (HPeV) has emerged as a pathogen causing sepsis-like presentations in young infants, but there is a lack of data on HPeV presentations requiring intensive care support. We aimed to characterise the clinical presentation, disease severity, management and outcome of a population-based cohort of children with microbiologically confirmed HPeV infection requiring admission to paediatric intensive care units (PICUs) in Queensland, Australia during a recent outbreak. Methods: This was a multicentre retrospective study of children admitted to PICU between 1 January 2015 and 31 December 2016 with confirmed HPeV infection. Results: Thirty infants (median age 20 days) with HPeV genotype 3 were admitted to PICU, representing 16% of all children with HPeV admitted to hospital and 6.4% of non-elective PICU admissions in children <1 year of age. Children requiring PICU admission were younger than children admitted to hospital (P = 0.001). Apnoea, haemodynamic instability with tachycardia and seizures represented the main reasons for PICU admission. Eleven children (37%) required mechanical ventilation for a median duration of 62 h, 22 (73%) received fluid boluses and 7 (23%) were treated with vasoactive agents for a median duration of 53 h. Median length of stay was 2.62 days. A total of 24 children (80%) fulfilled sepsis criteria, 14 (47%) severe sepsis and 7 (23%) septic shock criteria. Eight (27%) had abnormal brain magnetic resonance imaging. No patient died. Conclusions: We confirm that HPeV infection is an important cause of sepsis-like syndrome in infants with substantial associated morbidity. Optimal management and long-term outcomes require further investigation.

show abstract

“…Schlapbach et al analysed data from a cohort of paediatric sepsis patients in PICU to predict mortality from variables available within 1 h of admission. They observed a mortality rate of 8.5%, with nearly half the deaths occurring within the first 48 h of PICU admission [12].…”

Section: Sepsismentioning

confidence: 99%