Adherence to PALS Sepsis Guidelines and Hospital Length of Stay
Adherence to PALS Sepsis Guidelines and Hospital Length of Stay
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DOI：
10.1542/peds.2012-0094
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发表时间：
2012-08-01
期刊：
影响因子：
8
通讯作者：
Melendez, Elliot
中科院分区：
文献类型：
--
作者：
Paul, Raina;Neuman, Mark I.;Melendez, Elliot
背景和结论：很少有研究评价了三级儿科急诊室脓毒症指南的依从性。我们试图评估（1）遵守2006年儿科高级生命支持指南严重脓毒症和脓毒性休克（SS），（2）遵守的障碍，和（3）住院时间（LOS）视指南adherence.METHODS：前瞻性队列研究的儿童提出一个大型城市学术儿科急诊科SS。对5个算法时间特异性目标的遵守情况进行了审查：SS的早期识别、获得血管通路、静脉输液、液体难治性休克的血管加压药输送和抗生素给药。审查了对每个时间定义目标的遵守情况以及对所有5个组件的遵守情况。详细的电子病历分析评价了依从性障碍。采用多变量负二项回归分析评价指南依从性与医院LOS之间的相关性。结果：共有126例患者发生严重脓毒症（14%）或脓毒性休克（86%）。中位年龄为9岁（四分位距，3-16岁）。分别有37%和35%的遵守率液体和正性肌力药指南。19%的人坚持5组分束。在60分钟内接受60 mL/kg静脉输液的患者比未接受静脉输液的儿童的住院时间短57%（P = 0.039）。完全捆绑依从性导致住院时间缩短57%（P = .009）。结论：总体依从性儿科高级生命支持脓毒症指南较低;然而，当患者在指南的建议范围内进行管理时，患者的住院时间显著缩短。儿科2012; 130：e273-e280
BACKGROUND AND OBJECTIVES: Few studies have evaluated sepsis guideline adherence in a tertiary pediatric emergency department setting. We sought to evaluate (1) adherence to 2006 Pediatric Advanced Life Support guidelines for severe sepsis and septic shock (SS), (2) barriers to adherence, and (3) hospital length of stay (LOS) contingent on guideline adherence.METHODS: Prospective cohort study of children presenting to a large urban academic pediatric emergency department with SS. Adherence to 5 algorithmic time-specific goals was reviewed: early recognition of SS, obtaining vascular access, administering intravenous fluids, delivery of vasopressors for fluid refractory shock, and antibiotic administration. Adherence to each time-defined goal and adherence to all 5 components as a bundle were reviewed. A detailed electronic medical record analysis evaluated adherence barriers. The association between guideline adherence and hospital LOS was evaluated by using multivariate negative binomial regression.RESULTS: A total of 126 patients had severe sepsis (14%) or septic shock (86%). The median age was 9 years (interquartile range, 3-16). There was a 37% and 35% adherence rate to fluid and inotrope guidelines, respectively. Nineteen percent adhered to the 5-component bundle. Patients who received 60 mL/kg of intravenous fluids within 60 minutes had a 57% shorter hospital LOS (P = .039) than children who did not. Complete bundle adherence resulted in a 57% shorter hospital LOS (P = .009).CONCLUSIONS: Overall adherence to Pediatric Advanced Life Support sepsis guidelines was low; however, when patients were managed within the guideline's recommendations, patients had significantly shorter duration of hospitalization. Pediatrics 2012; 130:e273-e280