Texas Children's Hospital and the University of Texas Health Science Center, Houston Cizik School of Nursing, Houston, Texas, United States.
Texas Children's Hospital, Houston, Texas, United States.
Appl Clin Inform. 2021 May;12(3):469-478. doi: 10.1055/s-0041-1730027. Epub 2021 May 26.
Severe sepsis can cause significant morbidity and mortality in pediatric patients. Early recognition and treatment are vital to improving patient outcomes.
The study aimed to evaluate the impact of a best practice alert in improving recognition of sepsis and timely treatment to improve mortality in the pediatric acute care setting.
A multidisciplinary team adapted a sepsis alert from the emergency room setting to facilitate identification of sepsis in acute care pediatric inpatient areas. The sepsis alert included clinical decision support to aid in timely treatment, prompting the use of intravenous fluid boluses, and antibiotic administration. We compared sepsis-attributable mortality, time to fluid and antibiotic administration, proportion of patients who required transfer to a higher level of care, and antibiotic days for the year prior to the sepsis alert (2017) to the postimplementation phase (2019).
We had 79 cases of severe sepsis in 2017 and 154 cases in 2019. Of these, we found an absolute reduction in both 3-day sepsis-attributable mortality (2.53 vs. 0%) and 30-day mortality (3.8 vs. 1.3%) when comparing the pre- and postintervention groups. Though our analysis was underpowered due to small sample size, we also identified reductions in median time to fluid and antibiotic administration, proportion of patients who were transferred to the intensive care unit, and no observable increase in antibiotic days.
Electronic sepsis alerts may assist in improving recognition of sepsis and support timely antibiotic and fluid administration in pediatric acute care settings.
严重脓毒症可导致儿科患者出现重大发病率和死亡率。早期识别和治疗对改善患者预后至关重要。
本研究旨在评估最佳实践警报对改善儿科急症护理环境中脓毒症识别和及时治疗以降低死亡率的影响。
一个多学科团队从急诊室环境中改编了一个脓毒症警报，以促进急性护理儿科住院区脓毒症的识别。脓毒症警报包括临床决策支持，以帮助及时治疗，提示使用静脉输液冲击量和抗生素给药。我们比较了脓毒症相关死亡率、液体和抗生素给药时间、需要转至更高级别护理的患者比例以及实施脓毒症警报前一年（2017 年）和实施后一年（2019 年）的抗生素使用天数。
我们在 2017 年有 79 例严重脓毒症病例，在 2019 年有 154 例。在这些病例中，我们发现与干预前组相比，3 天脓毒症相关死亡率（2.53%比 0%）和 30 天死亡率（3.8%比 1.3%）均有绝对降低。尽管由于样本量小，我们的分析效力不足，但我们还发现液体和抗生素给药时间中位数、转至重症监护病房的患者比例以及抗生素使用天数无明显增加均有降低。
电子脓毒症警报可能有助于提高儿科急症护理环境中脓毒症的识别，并支持及时给予抗生素和液体治疗。
