Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Center, University of Michigan Health System, Ann Arbor, Michigan
Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Center, University of Michigan Health System, Ann Arbor, Michigan.
Pediatrics. 2017 Aug;140(2). doi: 10.1542/peds.2017-0350.
Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome.
Seven measures of quality of care for children hospitalized with sepsis syndrome were developed by using an iterative process including literature review, development of concepts and candidate measures, and selection of measures for feasibility and importance by 2 panels of experts. The measures were tested for reliability and validity among children 0 to 18 years of age hospitalized with sepsis syndrome from January 1, 2012, to June 30, 2013.
Of 27 hospitals, 59% had no protocol for the identification and treatment of pediatric sepsis syndrome. Blood culture was performed in only 70% of patients with pediatric sepsis syndrome. Antibiotics were administered within 1 hour of diagnosis in 70% of patients with pediatric severe sepsis or septic shock, and timely fluid resuscitation was performed in 50% of patients with severe sepsis or septic shock. Documentation of heart rate during fluid resuscitation of children with severe sepsis or septic shock was observed in 18% of cases. Two measures could not be rigorously tested for validity and reliability given the rarity of septic shock and were deemed infeasible.
This multisite study to develop and validate measures of the quality of hospital care of children with sepsis syndrome highlights the existence of important gaps in delivery of care.
脓毒症综合征包括脓毒症、严重脓毒症和脓毒性休克，是导致儿童死亡和发病的主要原因，及时提供治疗可提高存活率。本研究旨在描述儿童脓毒症综合征院内治疗质量措施的制定和检验。
采用迭代过程，通过文献回顾、概念和候选措施的制定以及由 2 个专家组对可行性和重要性进行的措施选择，制定了 7 项儿童脓毒症综合征护理质量措施。对 2012 年 1 月 1 日至 2013 年 6 月 30 日期间因脓毒症综合征住院的 0 至 18 岁儿童进行了这些措施的可靠性和有效性检验。
27 家医院中，59%的医院没有儿童脓毒症综合征的识别和治疗方案。仅对 70%的儿童脓毒症综合征患者进行了血培养。70%的儿童严重脓毒症或脓毒性休克患者在诊断后 1 小时内给予抗生素治疗，50%的严重脓毒症或脓毒性休克患者进行了及时的液体复苏。在严重脓毒症或脓毒性休克儿童的液体复苏过程中，仅 18%观察到心率的记录。由于脓毒性休克的罕见性，有 2 项措施的有效性和可靠性无法严格检验，被认为不可行。
本研究对脓毒症综合征患儿的医院治疗质量措施进行了制定和验证，突出了在提供治疗方面存在的重要差距。
