Hasan Gamal M, Al-Eyadhy Ayman A, Temsah Mohamed-Hani A, Al-Haboob Ali A, Alkhateeb Mohammad A, Al-Sohime Fahad
Intensive Care Unit, Department of Pediatrics, King Khalid University Hospital and College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Assiut University Children Hospital, Assiut University, Assiut, Egypt.
Int J Qual Health Care. 2018 Oct 1;30(8):587-593. doi: 10.1093/intqhc/mzy077.
Evaluation of feasibility and effectiveness of Surviving Sepsis Campaign (SSC) Guidelines implementation at a Pediatric Intensive Care Unit (PICU) in Saudi Arabia to reduce severe sepsis associated mortality.
Retrospective data analysis for a prospective quality improvement (QI) initiative.
PICU at King Saud University Medical City, Saudi Arabia.
Children ≤14 years of age admitted to the PICU from July 2010 to March 2011 with suspected or proven sepsis. Comparisons were made to a previously admitted group of patients with sepsis from October 2009 to June 2010.
Adaptation and implementation of the Surviving Sepsis Campaign-Clinical Practice Guidelines (SSC-CPGs) through AGREE instrument and ADAPTE process.
We reported pre- and post-implementation outcome of interest for this QI initiative, annual sepsis-related mortality rate. Furthermore, we reported follow-up of annual mortality rate until December 2016.
Sixty-five patients was included in the study (42 in post-guidelines implementation group and 23 in pre-guidelines implementation group). Mortality was insignificantly lower in the post-implementation group (26.2% vs. 47.8%; P = 0.079). However, when adjusted for severity, identified by number of failing organs in the multivariate regression analysis, the mortality difference was favorable for the post-implementation group (P = 0.006). The lower sepsis-related mortality rate was also sustained, with an average mortality rate of 15.11% for the subsequent years (2012-16).
Adaptation and implementation of SSC Guidelines in our setting support its feasibility and potential benefits. However, a larger study is recommended to explore detailed compliance rates.
评估在沙特阿拉伯一家儿科重症监护病房（PICU）实施脓毒症存活策略（SSC）指南以降低严重脓毒症相关死亡率的可行性和有效性。
对一项前瞻性质量改进（QI）计划进行回顾性数据分析。
沙特阿拉伯国王沙特大学医学城的PICU。
2010年7月至2011年3月入住PICU的14岁及以下疑似或确诊脓毒症患儿。与2009年10月至2010年6月之前收治的脓毒症患者组进行比较。
通过AGREE工具和ADAPTE流程对脓毒症存活策略临床实践指南（SSC-CPGs）进行调整和实施。
我们报告了这项QI计划实施前后的感兴趣结局，即年度脓毒症相关死亡率。此外，我们报告了截至2016年12月的年度死亡率随访情况。
65例患者纳入研究（指南实施后组42例，指南实施前组23例）。实施后组死亡率略低（26.2%对47.8%；P = 0.079）。然而，在多变量回归分析中根据衰竭器官数量确定严重程度进行调整后，死亡率差异对实施后组有利（P = 0.006）。较低的脓毒症相关死亡率也得以维持，随后几年（2012 - 16年）平均死亡率为15.11%。
在我们的环境中对SSC指南进行调整和实施支持其可行性和潜在益处。然而，建议进行更大规模的研究以探索详细的依从率。
