Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2012 Aug;130(2):e273-80. doi: 10.1542/peds.2012-0094. Epub 2012 Jul 2.
Few studies have evaluated sepsis guideline adherence in a tertiary pediatric emergency department setting. We sought to evaluate (1) adherence to 2006 Pediatric Advanced Life Support guidelines for severe sepsis and septic shock (SS), (2) barriers to adherence, and (3) hospital length of stay (LOS) contingent on guideline adherence.
Prospective cohort study of children presenting to a large urban academic pediatric emergency department with SS. Adherence to 5 algorithmic time-specific goals was reviewed: early recognition of SS, obtaining vascular access, administering intravenous fluids, delivery of vasopressors for fluid refractory shock, and antibiotic administration. Adherence to each time-defined goal and adherence to all 5 components as a bundle were reviewed. A detailed electronic medical record analysis evaluated adherence barriers. The association between guideline adherence and hospital LOS was evaluated by using multivariate negative binomial regression.
A total of 126 patients had severe sepsis (14%) or septic shock (86%). The median age was 9 years (interquartile range, 3-16). There was a 37% and 35% adherence rate to fluid and inotrope guidelines, respectively. Nineteen percent adhered to the 5-component bundle. Patients who received 60 mL/kg of intravenous fluids within 60 minutes had a 57% shorter hospital LOS (P = .039) than children who did not. Complete bundle adherence resulted in a 57% shorter hospital LOS (P = .009).
Overall adherence to Pediatric Advanced Life Support sepsis guidelines was low; however, when patients were managed within the guideline's recommendations, patients had significantly shorter duration of hospitalization.
很少有研究评估过三级儿科急诊环境中脓毒症指南的遵守情况。我们旨在评估（1）对 2006 年儿科高级生命支持严重脓毒症和脓毒性休克（SS）指南的遵守情况，（2）遵守的障碍，以及（3）根据指南遵守情况而定的住院时间（LOS）。
对患有 SS 的大量城市学术儿科急诊就诊的儿童进行前瞻性队列研究。回顾了 5 个算法时间特定目标的依从性：SS 的早期识别、获得血管通路、静脉输液、对液体难治性休克给予血管加压药以及抗生素的使用。回顾了每个时间定义目标的依从性以及作为一个捆绑包的所有 5 个组件的依从性。详细的电子病历分析评估了遵守障碍。通过使用多变量负二项回归评估了指南遵守与住院 LOS 之间的关联。
共有 126 名儿童患有严重脓毒症（14%）或脓毒性休克（86%）。中位年龄为 9 岁（四分位间距，3-16）。液体和儿茶酚胺类药物指南的依从率分别为 37%和 35%。19%的患者符合 5 个组件捆绑包的要求。在 60 分钟内接受 60ml/kg 静脉输液的患者住院时间缩短了 57%（P=0.039），而未接受该治疗的患者则延长了 57%（P=0.009）。完全遵守捆绑包可使住院时间缩短 57%（P=0.009）。
总体而言，儿科高级生命支持脓毒症指南的遵守率较低；然而，当患者按照指南的建议进行治疗时，患者的住院时间明显缩短。
