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Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments: A Multicenter Study in Latin
Insights
Pediatric septic shock (PSS) management in Latin American emergency departments shows poor adherence to international guidelines. This study highlights critical delays in treatment, impacting patient outcomes and increasing mortality rates.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Infectious Diseases
Background:
- Sepsis and pediatric septic shock (PSS) represent a significant global health challenge.
- Timely identification and treatment are crucial for reducing PSS-related mortality.
- International guidelines provide a framework for optimal PSS management.
Purpose of the Study:
- To investigate the epidemiology of pediatric septic shock in emergency departments.
- To evaluate adherence to the recommended first-hour management protocols for PSS.
- To identify factors influencing PSS treatment and outcomes.
Main Methods:
- A multicenter, prospective, cross-sectional study was conducted across 10 tertiary-care centers in Latin America.
- Data were collected on children diagnosed with PSS in the emergency department.
- Adherence to established PSS management guidelines was assessed.
Main Results:
- The study included 219 pediatric patients with PSS; 22% presented with hypotension, and 55% had impaired consciousness.
- Fluid and antibiotic administration occurred within median times of 30 and 40 minutes, respectively.
- Only 13% of patients achieved full adherence to all treatment goals, with a 10% mortality rate. Delays in vasoactive drug initiation were noted, particularly when central lines were prioritized.
Conclusions:
- Adherence to international recommendations for first-hour PSS management in Latin American emergency departments is suboptimal.
- Hypotension on admission was significantly associated with increased mortality.
- Improvements in guideline adherence are needed to reduce PSS-related morbidity and mortality.
Objective:
Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour.
Methods:
A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated.
Results:
We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001).
Conclusions:
We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.
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