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How Are Clinicians Treating Children With Sepsis in Emergency Departments in Latin America?: An International
Guillermo A Kohn-Loncarica, Ana L Fustiñana, Roberto M Jabornisky
1Unidad Emergencias, Hospital de Pediatría Prof. Dr. Juan P. Garrahan y Universidad de Buenos Aires, Buenos Aires.
Insights
Pediatric septic shock (PSS) management in Latin America shows variable adherence to guidelines. Treatment coordinated by pediatric emergency specialists (PEMS) significantly improves adherence to PSS care recommendations.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Global Health
Background:
- Effective management of pediatric septic shock (PSS) in emergency departments (EDs) is crucial for improving patient outcomes.
- Adherence to established guidelines is essential for optimal PSS care but can be influenced by resource availability and specialist involvement.
Purpose of the Study:
- To evaluate the adherence to PSS management guidelines in Latin American EDs.
- To compare the impact of treatment coordination by pediatric emergency medical specialists (PEMS) versus non-pediatric emergency medical specialists (NPEMS) on guideline adherence.
Main Methods:
- A prospective, descriptive, multicenter study was conducted across 14 Latin American countries.
- Electronic surveys were administered to PEMS and NPEMS managing PSS in EDs, yielding a 41.5% response rate from 2164 distributed surveys.
Main Results:
- Overall adherence to critical care guidelines for PSS varied, with notable gaps in fluid administration (32%) and specific vasopressor use (57-80%).
- PEMS demonstrated significantly higher adherence rates across all assessed guideline components compared to NPEMS (e.g., vascular access 87.1% vs. 72.7%, antibiotics 90.1% vs. 79.3%).
- Failure in sepsis recognition, including a lack of triage tools, was identified as a primary barrier to effective sepsis care.
Conclusions:
- Self-reported adherence to evidence-based PSS treatment recommendations within the first hour varies across Latin American countries.
- Coordination of PSS care by PEMS is associated with greater adherence to critical care guidelines, highlighting the importance of specialist involvement.
Objective:
Guidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence.
Methods:
Prospective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries.
Results:
We distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools.
Conclusions:
In some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.
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