Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Sci Rep. 2022 Jul 20;12(1):12436. doi: 10.1038/s41598-022-16632-2.
This study aimed to assess the potential impact of implementing an electronic alert system (EAS) for systemic inflammatory syndrome (SIRS) and sepsis in pediatric patients mortality. This retrospective study had a pre and post design. We enrolled patients aged ≤ 14 years who were diagnosed with sepsis/severe sepsis upon admission to the pediatric intensive care unit (PICU) of our tertiary hospital from January 2014 to December 2018. We implemented an EAS for the patients with SIRS/sepsis. The patients who met the inclusion criteria pre-EAS implementation comprised the control group, and the group post-EAS implementation was the experimental group. Mortality was the primary outcome, while length of stay (LOS) and mechanical ventilation in the first hour were the secondary outcomes. Of the 308 enrolled patients, 147 were in the pre-EAS group and 161 in the post-EAS group. In terms of mortality, 44 patients in the pre-EAS group and 28 in the post-EAS group died (p 0.011). The average LOS in the PICU was 7.9 days for the pre-EAS group and 6.8 days for the post-EAS group (p 0.442). Considering the EAS initiation time as the "zero time", early recognition of SIRS and sepsis via the EAS led to faster treatment interventions in post-EAS group, which included fluid boluses with median (25th, 75th percentile) time of 107 (37, 218) min vs. 30 (11,112) min, p < 0.001) and time to initiate antimicrobial therapy median (25th, 75th percentile) of 170.5 (66,320) min vs. 131 (53,279) min, p 0.042). The difference in mechanical ventilation in the first hour of admission was not significant between the groups (25.17% vs. 24.22%, p 0.895). The implementation of the EAS resulted in a statistically significant reduction in the mortality rate among the patients admitted to the PICU in our study. An EAS can play an important role in saving lives and subsequent reduction in healthcare costs. Further enhancement of systematic screening is therefore highly recommended to improve the prognosis of pediatric SIRS and sepsis. The implementation of the EAS, warrants further validation in multicenter or national studies.
本研究旨在评估在儿科患者死亡率中实施全身性炎症反应综合征（SIRS）和脓毒症电子警报系统（EAS）的潜在影响。这是一项回顾性研究，采用前后设计。我们招募了 2014 年 1 月至 2018 年 12 月在我们的三级医院儿科重症监护病房（PICU）入院时诊断为脓毒症/严重脓毒症的年龄≤14 岁的患者。我们为 SIRS/脓毒症患者实施了 EAS。符合 EAS 实施前纳入标准的患者为对照组，EAS 实施后为实验组。死亡率是主要结局，而住留时间（LOS）和第 1 小时的机械通气是次要结局。在 308 名纳入患者中，有 147 名在 EAS 前组，161 名在 EAS 后组。在死亡率方面，EAS 前组有 44 名患者死亡，EAS 后组有 28 名患者死亡（p=0.011）。EAS 前组 PICU 的平均 LOS 为 7.9 天，EAS 后组为 6.8 天（p=0.442）。考虑到 EAS 启动时间为“零时间”，通过 EAS 早期识别 SIRS 和脓毒症可导致 EAS 后组更快地进行治疗干预，包括输液中位数（25%，75%）时间为 107（37，218）min 比 30（11，112）min，p<0.001）和开始抗菌治疗的中位数（25%，75%）时间为 170.5（66，320）min 比 131（53，279）min，p=0.042）。入院第 1 小时机械通气的组间差异无统计学意义（25.17% vs. 24.22%，p=0.895）。EAS 的实施使我们研究中入住 PICU 的患者死亡率显著降低。EAS 可以在拯救生命和降低后续医疗保健成本方面发挥重要作用。因此，强烈建议进一步加强系统筛查，以改善儿科 SIRS 和脓毒症的预后。EAS 的实施需要在多中心或全国性研究中进一步验证。
