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Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience
Abdullah Alturki1, Ayman Al-Eyadhy2, Ali Alfayez3
1Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. aturki@kfshrc.edu.sa.
Insights
Implementing an electronic alert system (EAS) significantly reduced mortality in pediatric patients with systemic inflammatory syndrome (SIRS) and sepsis. This EAS improved early recognition and treatment, saving lives in the pediatric intensive care unit (PICU).
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Clinical systems implementation
Background:
- Systemic inflammatory syndrome (SIRS) and sepsis are critical conditions in pediatric patients.
- Early detection and intervention are crucial for improving outcomes in pediatric sepsis.
- Electronic alert systems (EAS) have the potential to enhance clinical decision-making and patient management.
Purpose of the Study:
- To evaluate the impact of an electronic alert system (EAS) on mortality rates in pediatric patients with SIRS and sepsis.
- To assess secondary outcomes including length of stay (LOS) and the initiation of mechanical ventilation.
- To determine if EAS implementation leads to faster treatment interventions for pediatric sepsis.
Main Methods:
- Retrospective pre- and post-implementation study design.
- Inclusion of pediatric patients (≤14 years) diagnosed with sepsis/severe sepsis admitted to the PICU.
- Comparison of mortality, LOS, and mechanical ventilation rates between pre-EAS (control) and post-EAS (experimental) groups.
Main Results:
- A statistically significant reduction in mortality was observed in the post-EAS group (28 deaths) compared to the pre-EAS group (44 deaths) (p=0.011).
- Early recognition via EAS led to faster initiation of fluid boluses (p<0.001) and antimicrobial therapy (p=0.042).
- No significant difference was found in the average PICU length of stay (p=0.442) or mechanical ventilation rates in the first hour (p=0.895).
Conclusions:
- Implementation of an EAS for SIRS and sepsis in pediatric patients significantly reduces mortality.
- EAS facilitates timely interventions, contributing to improved patient prognosis and potentially reducing healthcare costs.
- Further validation through multicenter studies is recommended to confirm the widespread effectiveness of EAS in pediatric sepsis management.
Abstract:
This study aimed to assess the potential impact of implementing an electronic alert system (EAS) for systemic inflammatory syndrome (SIRS) and sepsis in pediatric patients mortality. This retrospective study had a pre and post design. We enrolled patients aged ≤ 14 years who were diagnosed with sepsis/severe sepsis upon admission to the pediatric intensive care unit (PICU) of our tertiary hospital from January 2014 to December 2018. We implemented an EAS for the patients with SIRS/sepsis. The patients who met the inclusion criteria pre-EAS implementation comprised the control group, and the group post-EAS implementation was the experimental group. Mortality was the primary outcome, while length of stay (LOS) and mechanical ventilation in the first hour were the secondary outcomes. Of the 308 enrolled patients, 147 were in the pre-EAS group and 161 in the post-EAS group. In terms of mortality, 44 patients in the pre-EAS group and 28 in the post-EAS group died (p 0.011). The average LOS in the PICU was 7.9 days for the pre-EAS group and 6.8 days for the post-EAS group (p 0.442). Considering the EAS initiation time as the "zero time", early recognition of SIRS and sepsis via the EAS led to faster treatment interventions in post-EAS group, which included fluid boluses with median (25th, 75th percentile) time of 107 (37, 218) min vs. 30 (11,112) min, p < 0.001) and time to initiate antimicrobial therapy median (25th, 75th percentile) of 170.5 (66,320) min vs. 131 (53,279) min, p 0.042). The difference in mechanical ventilation in the first hour of admission was not significant between the groups (25.17% vs. 24.22%, p 0.895). The implementation of the EAS resulted in a statistically significant reduction in the mortality rate among the patients admitted to the PICU in our study. An EAS can play an important role in saving lives and subsequent reduction in healthcare costs. Further enhancement of systematic screening is therefore highly recommended to improve the prognosis of pediatric SIRS and sepsis. The implementation of the EAS, warrants further validation in multicenter or national studies.
