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Published on: November 3, 2023
Clinical spectrum of shock in the pediatric emergency department
Jay D Fisher1, David G Nelson, Heidi Beyersdorf
1Department of Emergency Medicine, University Medical Center, University of Nevada School of Medicine, Las Vegas, NV, USA. jdfisher1@cox.net
Insights
Pediatric emergency department patients with shock have diverse causes, with sepsis being most common. Some patients developed shock after initial presentation, highlighting the need for vigilance.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care Medicine
- Pediatric Critical Care
Background:
- Shock in children presenting to the emergency department (ED) is a critical condition with significant morbidity and mortality.
- Understanding the diverse etiologies and clinical presentations of pediatric shock is crucial for timely diagnosis and management.
Purpose of the Study:
- To delineate the clinical spectrum of pediatric patients who presented with or developed shock in a pediatric ED over an eight-year period.
- To identify the common causes, management strategies, and outcomes of pediatric shock.
Main Methods:
- An observational study was conducted on pediatric ED patients diagnosed with shock between September 1998 and September 2006.
- Trauma cases were excluded. Data were collected via a structured chart review by board-certified pediatric emergency medicine physicians.
- Interrater reliability was assessed to ensure data accuracy.
Main Results:
- A total of 147 pediatric shock cases were identified. Septic shock accounted for 57% of cases, with a pathogen identified in 45%.
- Hypovolemic shock (24%), distributive shock (14%), and cardiogenic shock (5%) were other significant causes.
- 14% of patients developed shock after initial presentation, some after antimicrobial administration or lumbar puncture. Overall mortality was 6%.
Conclusions:
- Pediatric shock in the ED is a heterogeneous condition associated with considerable mortality.
- A significant proportion of patients deteriorate within the ED, emphasizing the importance of continuous monitoring and early recognition.
Objective:
The objective of this study was to describe the clinical spectrum of patients presenting with shock or developing shock in a pediatric emergency department (ED) during an 8-year period.
Methods:
An observational study of all pediatric ED patients with shock between September 1998 and September 2006 was performed. Trauma activations were excluded. A structured, explicit chart review using a standardized abstraction form and case definition was completed by 3 physicians board certified in pediatric emergency medicine. Interrater reliability was monitored.
Results:
A total of 147 cases of shock were identified. Septic shock was the underlying physiology in 57% of cases. A pathogen was identified in 45% of these cases. Hypovolemic shock due to gastroenteritis, metabolic disease, surgical emergencies, or hemorrhage was the cause in 24% of cases. Distributive shock represented 14% of cases. Cardiogenic shock contributed to 5% of cases. Patients with septic shock received a mean of 58 mL/kg of crystalloid or colloid versus 50 mL/kg in patients with other causes. Intubation and vasopressor use was required in 41% and 21% of cases, respectively. Clinical signs of shock developed in the ED after initially presenting without clinical signs of shock in 14% of study subjects. Nearly half of these episodes occurred after the administration of antimicrobials or performance of a lumbar puncture. Mortality was 6% overall and 5% in septic shock patients.
Conclusions:
Pediatric ED patients with shock represent a diverse population with substantial mortality. Of 147 patients, 21 presented without clinical signs of shock and deteriorated to a clinical condition meeting the definition of shock during the ED course.
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