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Prehospital Recognition and Management of Pediatric Sepsis: A Qualitative Assessment
Chelsea B Kadish1,2, Julia K Lloyd1,2, Kathleen M Adelgais3
1Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Recognizing and managing pediatric sepsis in emergency medical services (EMS) requires addressing environmental and educational barriers. Interventions like improved training and clear guidelines can enhance prehospital care for critically ill children.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Public Health
Background:
- Sepsis is a critical, life-threatening condition in children, posing significant morbidity and mortality risks.
- Early prehospital recognition and management are crucial for timely resuscitation in pediatric sepsis cases.
- Prehospital care for acutely ill children presents unique challenges.
Purpose of the Study:
- To investigate barriers, facilitators, and attitudes toward pediatric sepsis recognition and management in the prehospital setting.
- To identify factors influencing the care of septic children by EMS professionals.
- To inform the development of targeted interventions for improving prehospital pediatric sepsis care.
Main Methods:
- A qualitative study employing focus groups with EMS administrators, medical directors, and field clinicians.
- Grounded theory-based design and consensus methodology for data analysis.
- Application of the PRECEDE-PROCEED model to organize identified factors.
Main Results:
- Thirty-eight participants identified nine environmental, 21 negative, and 14 positive factors related to pediatric sepsis care.
- Pediatric sepsis guidelines were noted as positive when available and negative when complex or absent.
- Six key interventions were proposed: increased awareness, enhanced pediatric education, feedback mechanisms, skills training, and improved dispatch information.
Conclusions:
- This study addresses a critical gap in understanding prehospital pediatric sepsis management barriers and facilitators.
- Identified factors and proposed interventions provide a framework for improving care.
- Results support policy changes and future research to optimize prehospital pediatric sepsis outcomes.
Background And Purpose:
Sepsis is a life-threatening disease in children and is a leading cause of morbidity and mortality. Early prehospital recognition and management of children with sepsis may have significant effects on the timely resuscitation of this high-risk clinical condition. However, the care of acutely ill and injured children in the prehospital setting can be challenging. This study aims to understand barriers, facilitators, and attitudes regarding recognition and management of pediatric sepsis in the prehospital setting.
Methods:
This was a qualitative study of EMS professionals participating in focus groups using a grounded theory-based design to gather information on recognition and management of septic children in the prehospital setting. Focus groups were held for EMS administrators and medical directors. Separate focus groups were held for field clinicians. Focus groups were conducted via video conference until saturation of ideas was reached. Using consensus methodology, transcripts were coded in an iterative process. Data were then organized into positive and negative factors based on the validated PRECEDE-PROCEED model for behavioral change.
Results:
Thirty-eight participants in six focus groups identified nine environmental factors, 21 negative factors, and 14 positive factors pertaining to recognition and management of pediatric sepsis. These findings were organized into the PRECEDE-PROCEED planning model. Pediatric sepsis guidelines were identified as positive factors when they did exist and negative factors when they were complicated or did not exist. Six interventions were identified by participants. These include raising awareness of pediatric sepsis, increasing pediatric education, receiving feedback on prehospital encounters, increasing pediatric exposure and skills training, and improving dispatch information.
Conclusion:
This study fills a gap by examining barriers and facilitators to prehospital diagnosis and management of pediatric sepsis. Using the PRECEDE-PROCEED model, nine environmental factors, 21 negative factors, and 14 positive factors were identified. Participants identified six interventions that could create the foundation to improve prehospital pediatric sepsis care. Policy changes were suggested by the research team based on the results of this study. These interventions and policy changes provide a roadmap for improving care in this population and lay the groundwork for future research.
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