Related Experiment Video
Updated: Mar 17, 2026
Standardized Colon Ascendens Stent Peritonitis in Rats - a Simple, Feasible Animal Model to Induce Septic Acute Kidney Injury
Published on: February 15, 2022
Protocolized Treatment Is Associated With Decreased Organ Dysfunction in Pediatric Severe Sepsis
Fran Balamuth1, Scott L Weiss, Julie C Fitzgerald
11Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 2Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 3Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA. 4Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA. 5Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA. 6Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 7Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
Protocolized sepsis guidelines in the emergency department significantly improved organ dysfunction resolution in pediatric severe sepsis patients by hospital day 2. This approach enhances pediatric patient morbidity outcomes.
Area of Science:
- Pediatric critical care medicine
- Sepsis management
- Emergency medicine
Background:
- Severe sepsis in children presents a significant challenge, often leading to organ dysfunction.
- Standard care protocols may vary, potentially impacting patient outcomes.
- Early and consistent management is crucial for improving sepsis outcomes.
Purpose of the Study:
- To evaluate the impact of a protocolized sepsis guideline in the emergency department on organ dysfunction in pediatric severe sepsis.
- To compare outcomes between protocolized care and usual non-protocolized care.
Main Methods:
- Retrospective cohort study conducted at a tertiary care children's hospital.
- Included pediatric patients (older than 56 days, younger than 18 years) with severe sepsis requiring PICU admission.
- Compared outcomes between patients treated with an emergency department sepsis guideline and those receiving usual care.
Main Results:
- Patients treated with the protocolized guideline showed a significantly higher likelihood of being free from organ dysfunction by hospital day 2 (adjusted odds ratio, 4.2).
- No significant baseline differences were observed between the protocolized and usual care groups.
- The association remained significant after controlling for multiple clinical factors.
Conclusions:
- Implementation of a protocolized emergency department sepsis guideline is independently associated with improved resolution of organ dysfunction in pediatric severe sepsis.
- Protocolized care can lead to better morbidity outcomes in children with severe sepsis.
- These findings support the widespread adoption of standardized sepsis management protocols in pediatric emergency settings.
Objectives:
To determine whether treatment with a protocolized sepsis guideline in the emergency department was associated with a lower burden of organ dysfunction by hospital day 2 compared to nonprotocolized usual care in pediatric patients with severe sepsis.
Design:
Retrospective cohort study.
Setting:
Tertiary care children's hospital from January 1, 2012, to March 31, 2014.
Subjects:
Patients older than 56 days old and younger than 18 years old with international consensus defined severe sepsis and who required PICU admission within 24 hours of emergency department arrival were included.
Measurements And Main Results:
The exposure was the use of a protocolized emergency department sepsis guideline. The primary outcome was complete resolution of organ dysfunction by hospital day 2. One hundred eighty nine subjects were identified during the study period. Of these, 121 (64%) were treated with the protocolized emergency department guideline and 68 were not. There were no significant differences between the groups in age, sex, race, number of comorbid conditions, emergency department triage level, or organ dysfunction on arrival to the emergency department. Patients treated with protocolized emergency department care were more likely to be free of organ dysfunction on hospital day 2 after controlling for sex, comorbid condition, indwelling central venous catheter, Pediatric Index of Mortality-2 score, and timing of antibiotics and IV fluids (adjusted odds ratio, 4.2; 95% CI, 1.7-10.4).
Conclusions:
Use of a protocolized emergency department sepsis guideline was independently associated with resolution of organ dysfunction by hospital day 2 compared to nonprotocolized usual care. These data indicate that morbidity outcomes in children can be improved with the use of protocolized care.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:20Acute Kidney Injury V: Interprofessional Care
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention