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Prevalence and Management of Septic Shock among Children Admitted at the Kenyatta National Hospital, Longitudinal
Varsha Vekaria-Hirani1, Rashmi Kumar1, Rachel N Musoke1
1Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
Insights
Paediatric septic shock affects 15.4% of admitted children, with a 70% mortality rate. Current care at KNH does not meet international guidelines, highlighting a critical need for improved management protocols for paediatric septic shock.
Area of Science:
- Paediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Paediatric septic shock is a severe sepsis complication with high mortality.
- International guidelines exist but are not universally adopted.
- This study documents current practices in a national referral hospital.
Purpose of the Study:
- Determine the prevalence of paediatric septic shock.
- Audit the management of septic shock against international guidelines.
- Assess the 72-hour outcomes of children with septic shock.
Main Methods:
- A longitudinal survey of 325 children (0-12 years) from September to October 2016.
- Data collected via standard questionnaire at Kenyatta National Hospital (KNH).
- Management audited against Surviving Sepsis Campaign Guidelines 2012 (SSCG).
Main Results:
- Prevalence of septic shock was 15.4% (50 children), median age 4 months.
- Clinician recognition occurred in 56% of cases; care levels did not meet SSCG 2012 standards.
- Mortality was 70% within 72 hours; infants had 82.6% case fatality. Lack of ventilation and hypotension increased mortality risk.
Conclusions:
- Septic shock has a 15.4% prevalence and high mortality at KNH.
- Current care does not align with SSCG 2012 recommendations.
- Local paediatric guidelines in Kenya require inclusion of septic shock management protocols.
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.
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