Harley Amanda, Lister Paula, Gilholm Patricia, Rice Michael, Venkatesh Bala, Johnston Amy N B, Massey Debbie, Irwin Adam, Gibbons Kristen, Schlapbach Luregn J
School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Qld, Australia.
Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.
Crit Care Explor. 2021 Nov 8;3(11):e0573. doi: 10.1097/CCE.0000000000000573. eCollection 2021 Nov.
To evaluate the implementation of a pediatric sepsis pathway in the emergency department as part of a statewide quality improvement initiative in Queensland, Australia.
Multicenter observational prospective cohort study.
Twelve emergency departments in Queensland, Australia.
Children less than 18 years evaluated for sepsis in the emergency department. Patients with signs of shock, nonshocked patients with signs of organ dysfunction, and patients without organ dysfunction were assessed.
Introduction of a pediatric sepsis pathway.
Process measures included compliance with and timeliness of the sepsis bundle, and bundle components. Process and outcome measures of children admitted to the ICU with sepsis were compared with a baseline cohort. Five-hundred twenty-three children were treated for sepsis including 291 with suspected sepsis without organ dysfunction, 86 with sepsis-associated organ dysfunction, and 146 with septic shock. Twenty-four (5%) were admitted to ICU, and three (1%) died. The median time from sepsis recognition to bundle commencement for children with septic shock was 56 minutes (interquartile range, 36-99 min) and 47 minutes (interquartile range, 34-76 min) for children with sepsis-associated organ dysfunction without shock; 30% ( = 44) and 40% ( = 34), respectively, received the bundle within the target timeframe. In comparison with the baseline ICU cohort, bundle compliance improved from 27% ( = 45) to 58% ( = 14) within 60 minutes of recognition and from 47% ( = 78/167) to 75% ( = 18) within 180 minutes of recognition ( < 0.05).
Our findings on the introduction of protocolized care in a large and diverse state demonstrate ongoing variability in sepsis bundle compliance. Although bundle compliance improved compared with a baseline cohort, continued efforts are required to ensure guideline targets and sustainability are achieved.
作为澳大利亚昆士兰州一项全州范围质量改进计划的一部分，评估急诊科小儿脓毒症诊疗路径的实施情况。
多中心观察性前瞻性队列研究。
澳大利亚昆士兰州的12个急诊科。
在急诊科接受脓毒症评估的18岁以下儿童。对有休克体征的患者、无休克但有器官功能障碍体征的患者以及无器官功能障碍的患者进行评估。
引入小儿脓毒症诊疗路径。
过程指标包括脓毒症集束治疗的依从性和及时性以及集束治疗的组成部分。将脓毒症患儿入住重症监护病房（ICU）的过程指标和结局指标与一个基线队列进行比较。523名儿童接受了脓毒症治疗，其中291名疑似脓毒症但无器官功能障碍，86名患有脓毒症相关器官功能障碍，146名患有感染性休克。24名（5%）入住ICU，3名（1%）死亡。感染性休克患儿从脓毒症识别到开始集束治疗的中位时间为56分钟（四分位间距，36 - 99分钟），无休克的脓毒症相关器官功能障碍患儿为47分钟（四分位间距，34 - 76分钟）；分别有30%（n = 44）和40%（n = 34）在目标时间范围内接受了集束治疗。与基线ICU队列相比，识别后60分钟内集束治疗的依从性从27%（n = 45）提高到58%（n = 14），识别后180分钟内从47%（n = 78/167）提高到75%（n = 18）（P < 0.05）。
我们在一个规模大且多样化的州引入规范化治疗的研究结果表明，脓毒症集束治疗的依从性仍存在差异。尽管与基线队列相比集束治疗的依从性有所提高，但仍需持续努力以确保达到指南目标并实现可持续性。
