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

Abstract

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.

Socio-demographic characteristics and pre-hospital care of children with circulatory failure in a children's emergency room in southern Nigeria

“…In contrast, Vekaria-Hirani et al . [ 10 ] in Kenya found that septic shock was commoner in the younger age groups with infants having the highest case fatality rates, apparently due to a majority of their participants being infants, including neonates. Moreover, the duration of the illnesses before admission in CHER as well as gender was not significantly associated with shock in this study; this may be due to the overall shortness of disease duration among our participants.…”

“…The quality of care and referral threshold of referring hospitals as well as the expertise of transport team can influence the severity of illness at presentation in a tertiary centre [ 10 , 25 ]. In this index study, the source of referral was significantly associated with the presence of shock at presentation; children arriving from private clinic were twice more likely to present with circulatory failure in CHER.…”

“…There are several disease-related and patient-related factors that can predispose children to circulatory failure [ 9 , 10 ]. Prompt recognition of these characteristics can facilitate case-specific evaluation and treatment of at-risk children.…”

Barriers and Proposed Solutions to a Successful Implementation of Pediatric Sepsis Protocols

“…Maitland et al reported an increase in mortality after fluids bolus in African children with severe infection (44). Studies by Kortz et al (Tanzania) and Vekaria-Hirani et al (Naroby) did not observe reduction on mortality after a protocol implementation (34,45). Kortz et al even observed an increase in length of stay after protocol implementation caused by complications of treatment (34).…”

Impacto da implantação do protocolo de sepse pediátrico em hospital público de São Paulo, no período de 2015 a 2016

“…Os autores do estudo discutiram que os fatores que poderiam estar associados ao óbito precoce seriam: indisponibilidade de leitos de UTI, atraso no reconhecimento e tratamento, falta de atenção às diretrizes e dificuldade de transferência para serviço terciário. 19 O fato de que os pacientes apresentavam à admissão várias disfunções orgânicas pode refletir uma chegada tardia ao hospital. Launay et al…”