Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Emerg Med Australas. 2024 Jun;36(3):436-442. doi: 10.1111/1742-6723.14381. Epub 2024 Feb 25.
Clinical practice guidelines (CPGs) are an important tool for the management of children with sepsis. The quality, consistency and concordance of Australian and New Zealand (ANZ) childhood sepsis CPGs with the Australian Commission on Safety and Quality in Healthcare (ACSQHC) sepsis clinical care standards and international sepsis guidelines is unclear.
We accessed childhood sepsis CPGs for all ANZ states and territories through Paediatric Research in Emergency Departments International Collaborative members. The guidelines were assessed for quality using the AGREE-II instrument. Consistency between CPG treatment recommendations was assessed, as was concordance with the ACSQHC sepsis clinical care standards and international sepsis guidelines.
Overall, eight CPGs were identified and assessed. CPGs used a narrative and pathway format, with those using both having the highest quality overall. CPG quality was highest for description of scope and clarity of presentation, and lowest for editorial independence. Consistency between guidelines for initial treatment recommendations was poor, with substantial variation in the choice and urgency of empiric antimicrobial administration; the choice, volume and urgency of fluid resuscitation; and the choice of first-line vasoactive agent. Most CPGs were concordant with time-critical components of the ACSQHC sepsis clinical care standard, although few addressed post-acute care. Concordance with international sepsis guidelines was poor.
Childhood sepsis CPGs in current use in ANZ are of variable quality and lack consistency with key treatment recommendations. CPGs are concordant with the ACSQHC care standard, but not with international sepsis guidelines. A bi-national sepsis CPG may reduce unnecessary variation in care.
临床实践指南（CPG）是管理儿童脓毒症的重要工具。澳大利亚和新西兰（ANZ）儿童脓毒症 CPG 与澳大利亚安全与质量医疗保健委员会（ACSQHC）脓毒症临床护理标准和国际脓毒症指南的质量、一致性和一致性尚不清楚。
我们通过儿科急诊研究国际合作组织的成员访问了所有 ANZ 州和地区的儿童脓毒症 CPG。使用 AGREE-II 工具评估指南的质量。评估 CPG 治疗建议的一致性，以及与 ACSQHC 脓毒症临床护理标准和国际脓毒症指南的一致性。
总体而言，确定并评估了 8 项 CPG。CPG 采用叙述和途径格式，同时使用两者的 CPG 总体质量最高。CPG 质量在描述范围和表述清晰度方面最高，在编辑独立性方面最低。初始治疗建议指南之间的一致性较差，经验性抗菌药物治疗的选择和紧迫性存在很大差异；液体复苏的选择、容量和紧迫性；以及一线血管活性药物的选择。大多数 CPG 与 ACSQHC 脓毒症临床护理标准的时间关键组件一致，尽管很少涉及急性后护理。与国际脓毒症指南的一致性较差。
目前在 ANZ 使用的儿童脓毒症 CPG 的质量参差不齐，并且缺乏与关键治疗建议的一致性。CPG 与 ACSQHC 护理标准一致，但与国际脓毒症指南不一致。两国脓毒症 CPG 可能会减少护理中的不必要差异。
