Related Experiment Video
Updated: Aug 1, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Poor Compliance with Sepsis Guidelines in a Tertiary Care Children's Hospital Emergency Room
Benjamin Louis Moresco1,2, Clinton Woosley1,2, Morris Sauter2
1Baylor College of Medicine, Houston, TX, United States.
Insights
Pediatric sepsis guideline adherence in the ER was low, with factors like difficult vascular access and delayed antibiotics contributing to non-adherence. Improving these areas is crucial for better pediatric sepsis management.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care Medicine
- Infectious Diseases
Background:
- Severe sepsis and septic shock are critical conditions in children requiring prompt and guideline-adherent care.
- The Pediatric Advanced Life Support (PALS) guidelines provide a framework for managing pediatric sepsis in emergency settings.
Purpose of the Study:
- To evaluate adherence to PALS guidelines for severe sepsis and septic shock in a pediatric emergency room.
- To identify factors associated with adherence and non-adherence to these critical care guidelines.
Main Methods:
- A retrospective observational study was conducted on pediatric patients (0-18 years) diagnosed with severe sepsis or septic shock.
- Adherence was defined by meeting all three criteria: rapid vascular access, timely fluid administration, and prompt antibiotic administration.
- Statistical analyses included Student's t-test and chi-square test to compare groups.
Main Results:
- Overall adherence to PALS guidelines was low, with specific adherence rates of 21% for vascular access, 26% for fluids, and 34% for antibiotics.
- Factors associated with non-adherence included more than one attempt at vascular access, delayed antibiotic orders, and fluid administration via infusion pump.
- Patients in the non-adherent group were less likely to present with hypotension or multiple organ dysfunction.
Conclusions:
- Adherence to PALS guidelines for pediatric severe sepsis and septic shock in the emergency room setting is suboptimal.
- Interventions should focus on improving vascular access, streamlining antibiotic ordering, and optimizing fluid resuscitation strategies.
- Addressing these factors may improve outcomes for critically ill children with sepsis.
Objectives:
This study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children's hospital.
Methods:
This was a retrospective, observational study of children (0-18 years old) in The Children's Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for "severe sepsis" and "shocks." Patients in the adherent group were those who met all three elements of adherence: (1) rapid vascular access with at most one IV attempt before seeking alternate access (unless already in place), (2) fluids administered within 15 min from sepsis recognition, and (3) antibiotic administration started within 1 h of sepsis recognition. Comparisons between groups with and without sepsis guideline adherence were performed using Student's t-test (the measurements expressed as median values). The proportions were compared using chi-square test. p-Value ≤0.05 was considered significant.
Results:
A total of 43 patients who visited the ER from July 2014 to July 2015 had clinically proven severe sepsis or SS ICD-9 codes. The median age was 5 years. The median triage time, times from triage to vascular access, fluid administration and antibiotic administration were 26, 48.5, 76, and 135 min, respectively. Adherence to vascular access, fluid, and antibiotic administration guidelines was 21, 26, and 34%, respectively. Appropriate fluid bolus (20 ml/kg over 15-20 min) was only seen in 6% of patients in the non-adherent group versus 38% in the adherent group (p = 0.01). All of the patients in the non-adherent group used an infusion pump for fluid resuscitation. Hypotension and ≥3 organ dysfunction were more commonly observed in patients in adherent group as compared to patients in non-adherent group (38 vs. 14% p = 0.24; 63 vs. 23% p = 0.03).
Conclusion:
Overall adherence to sepsis guidelines was low. The factors associated with non-adherence to sepsis guidelines were >1 attempt at vascular access, delay in antibiotic ordering, fluid administration using infusion pump, absence of hypotension, and absence of three or more organs in dysfunction at ER presentation.
