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Survey of Thai Physicians' Practice in Pediatric Septic Shock
Sirapoom Niamsanit1, Teerapat Saengthongpitag2, Rattapon Uppala1
1Department of Pediatrics, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Muang, Khon Kaen 40002, Thailand.
Insights
Thai physicians show significant knowledge gaps in pediatric sepsis management, particularly regarding fluid resuscitation and vasoactive agents for cold shock. Regular training is recommended to improve adherence to clinical guidelines.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Practice Guidelines
- Sepsis Management
Background:
- Effective emergency management of pediatric sepsis is critical.
- This study assesses Thai physicians' understanding and application of current pediatric sepsis clinical practice guidelines.
- Knowledge gaps and adherence issues were investigated.
Purpose of the Study:
- To evaluate Thai physicians' knowledge gaps in the emergency management of pediatric sepsis.
- To assess adherence to current sepsis clinical practice guidelines among Thai physicians.
- To identify factors influencing guideline-based decision-making in pediatric septic shock management.
Main Methods:
- A cross-sectional survey was conducted using online questionnaires from March to April 2019.
- 366 Thai physicians, primarily general practitioners, responded to the survey.
- Data on sepsis management practices, including fluid resuscitation and vasoactive agent selection, were collected.
Main Results:
- While 83.9% initiated physician evaluation within 15 minutes of sepsis screening, only 56.3% followed guideline-recommended fluid loading doses (20 mL/kg).
- Guideline adherence for the first vasoactive agent in warm shock (norepinephrine) was 74.3%, but significantly lower for cold shock (epinephrine) at 36.2%.
- Pediatricians demonstrated better knowledge than general practitioners regarding initial fluid resuscitation and cold shock vasoactive agents (p < 0.001). Specialist training and sepsis management certification were associated with guideline adherence, while >10 years of experience was inversely associated.
Conclusions:
- Thai clinicians exhibit unfamiliarity with pediatric sepsis therapy standards, specifically concerning early fluid resuscitation volumes and appropriate vasoactive medications for cold shock.
- Significant differences in knowledge and practice exist between general practitioners and pediatricians.
- Regularly mandated training courses on pediatric sepsis management are proposed to enhance guideline adherence.
Abstract:
(1) Background: Sepsis management in children is crucial, especially in emergency services. This study aims to evaluate Thai physicians' knowledge gaps in the emergency management of sepsis in children and to evaluate their adherence to the current sepsis clinical practice guidelines. (2) Methods: This is a cross-sectional survey of Thai physicians' management of septic shock in children. The survey was conducted through online questionnaires from March 2019-April 2019. (3) Results: Of the 366 responders, 362 (98.9%) were completed. Most of the responders were general practitioners (89.2%) and pediatricians (10.8%). The time from positive sepsis screening to being evaluated by physicians within 15 min was reported by 83.9%. The most common choice of fluid resuscitation was normal saline solution (77.3%). The practice of a fluid loading dose (20 mL/kg) consistent with the guidelines was 56.3%. The selection of the first vasoactive agent in warm shock (norepinephrine) and cold shock (epinephrine) according to recommendations in the guidelines was 74.3% and 36.2%, respectively. There was a significant difference between general practitioners and pediatricians in terms of knowledge about initial fluid resuscitation and the optimal vasoactive agent in cold shock (p-value < 0.001). In the multivariate model, factors associated with the guideline-based decision-making of vasoactive agent choice for cold shock were specialist training (pediatrician) and the completion of sepsis management training certification, with adjusted odds ratios (AORs) of 7.81 and 2.96, but working experience greater than ten years was inconsistent with the guideline-based decision-making (AOR 0.14). (4) Conclusions: Thai clinicians were unfamiliar with pediatric sepsis therapy standards, specifically the quantity of early fluid resuscitation and the appropriate vasoactive medications for cold shock. To encourage adherence to the guidelines, we propose a regularly required training course on pediatric sepsis management.
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