Functional Outcomes and Morbidity in Pediatric Sepsis Survivors: A Tanzanian Experience.
Functional Outcomes and Morbidity in Pediatric Sepsis Survivors: A Tanzanian Experience.
复制标题
DOI：
10.3389/fped.2021.805518
复制
发表时间：
2021
影响因子：
2.6
通讯作者：
Kortz TB
中科院分区：
文献类型：
--
作者：
Lau-Braunhut SA;Smith AM;Steurer MA;Murray BL;Sawe H;Matthay MA;Reynolds T;Kortz TB
儿科败血症仍然是儿童发病率和死亡率的重要原因，不成比例地影响资源有限的环境。随着越来越多的患者存活，我们必须提高对脓毒症后发病率及其对功能结局影响的认识。功能状态量表（FSS）是一种经验证的儿科结局指标，用于量化功能障碍，以前曾在资源丰富的环境中证明危重疾病（包括脓毒症）后功能下降。然而，在资源有限的环境中或非危重败血症儿童中，从未研究过使用FSS治疗小儿败血症幸存者的功能结局。在坦桑尼亚的一组儿童脓毒症患者中，我们的目的是评估与急性脓毒症发作相关的发病率，使用资源有限的设置修改的FSS。这是一项在坦桑尼亚一家城市转诊医院进行的前瞻性队列研究，包括年龄在28天至14岁之间的脓毒症儿童，为期12个月。根据现场的可用资源对FSS进行了调整。功能状态量表得分是通过在陈述时和28天随访时采访监护人来确定儿童的基线。主要结局是“功能状态下降”，定义为FSS评分变化至少3分。在这个队列中，完成28天随访的1，359名存活儿童中有4.3%有“功能状态下降”。相反，13.8%的监护人报告他们的孩子尚未恢复到患病前的状态。报告未完全康复的儿童中有四分之三未通过FSS确定为功能状态下降。在我们的儿科脓毒症患者队列中，我们发现在资源有限的情况下使用FSS时功能状态下降率较低。较高比例的儿童被主观确定为未恢复至基线。这表明，FSS在这一人群中有局限性，尽管被改编为资源有限的设置。接下来的步骤包括开发和验证进一步修订的FSS，以更好地捕获被当前FSS识别为未恢复但遗漏的患者。
Pediatric sepsis remains a significant cause of childhood morbidity and mortality, disproportionately affecting resource-limited settings. As more patients survive, it is paramount that we improve our understanding of post-sepsis morbidity and its impact on functional outcomes. The functional status scale (FSS) is a pediatric validated outcome measure quantifying functional impairment, previously demonstrating decreased function following critical illnesses, including sepsis, in resource-rich settings. However, functional outcomes utilizing the FSS in pediatric sepsis survivors have never been studied in resource-limited settings or in non-critically ill septic children. In a Tanzanian cohort of pediatric sepsis patients, we aimed to evaluate morbidity associated with an acute septic episode using the FSS modified for resource-limited settings. This was a prospective cohort study at an urban referral hospital in Tanzania, including children with sepsis aged 28 days to 14 years old over a 12-month period. The FSS was adapted to the site's available resources. Functional status scale scores were obtained by interviewing guardians both at the time of presentation to determine the child's baseline and at 28-day follow-up. The primary outcome was “decline in functional status,” as defined by a change in FSS score of at least 3. In this cohort, 4.3% of the 1,359 surviving children completing 28-day follow-up had a “decline in functional status.” Conversely, 13.8% of guardians reported that their child was not yet back to their pre-illness state. Three-quarters of children reported as not fully recovered were not identified via the FSS as having a decline in functional status. In our cohort of pediatric sepsis patients, we identified a low rate of decline in functional status when using the FSS adapted for resource-limited settings. A higher proportion of children were subjectively identified as not being recovered to baseline. This suggests that the FSS has limitations in this population, despite being adapted for resource-limited settings. Next steps include developing and validating a further revised FSS to better capture patients identified as not recovered but missed by the current FSS.