Treatment of suspected sepsis and septic shock in children with chronic disease seen in the pediatric emergency department
Treatment of suspected sepsis and septic shock in children with chronic disease seen in the pediatric emergency department
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DOI：
10.1016/j.ajem.2021.01.026
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发表时间：
2021-02-10
影响因子：
3.6
通讯作者：
Depiero, Andrew D.
中科院分区：
文献类型：
--
作者：
Hegamyer, Emily;Smith, Nadine;Depiero, Andrew D.
背景：研究表明，及时识别和治疗脓毒症可以显着改善儿科患者的预后，特别是在静脉输液 (IVF) 和抗生素给药的时间方面。进一步的研究表明，脓毒症儿科患者的潜在慢性疾病使他们面临更高的不良结果风险。目的：比较儿科急诊科 (PED) 患有慢性病的儿科患者与无慢性病的儿科患者疑似脓毒症和感染性休克的治疗时间。方法：我们回顾了 2017 年 1 月至 2018 年 12 月在两家三级儿科医院收集的儿科败血症结果数据集中的患者数据。患者被分为两组：患有和不患有慢性疾病的患者，定义为患有至少八种慢性健康状况之一的任何患者。纳入标准：在 PED 中看到的患者最终诊断为败血症或败血性休克，患者年龄为 0 至 20 岁，且 PED 中败血症识别时间为零。排除标准：零时间不可用、无法确定首次 IVF 或抗生素施用的时间或患者在 PED 内死亡。主要分析包括比较每组之间第一次 IVF 的零时间和抗生素给药情况。结果：312 名患者符合纳入标准。 169 人患有慢性病，143 人没有。慢性病患者使用抗生素的中位时间为 41.9 分钟，而无慢性病患者则为 43.0 分钟 (p = 0.181)。患有慢性疾病的患者首次 IVF 的时间为 22.0 分钟，而没有慢性疾病的患者则为 12.0 分钟 (p = 0.010)。有留置管/导管的患者 (n = 40) 接受 IVF 的速度比没有留置管/导管的患者 (n = 272) 慢，留置导管状态对抗生素给药时间没有显着差异 (p = 0.063)。患有慢性疾病的人和没有慢性疾病的人之间，疑似败血症或败血性休克的识别模式没有显着差异（p = 0.27）。结论：研究结果表明，与无慢性病的患者相比，PED 中疑似脓毒症或脓毒性休克的慢性病儿科患者接受 IVF 的时间较慢，但脓毒症识别工具的使用模棱两可。 (c) 2021 Elsevier Inc. 保留所有权利。
Background: Research demonstrates that timely recognition and treatment of sepsis can significantly improve pediatric patient outcomes, especially regarding time to intravenous fluid (IVF) and antibiotic administration. Further research suggests that underlying chronic disease in a septic pediatric patient puts them at higher risk for poor outcomes. Objective: To compare treatment time for suspected sepsis and septic shock in pediatric patients with chronic disease versus those without chronic disease seen in the Pediatric Emergency Department (PED). Methods: We reviewed patient data from a pediatric sepsis outcomes dataset collected at two tertiary care pediatric hospital sites from January 2017-December 2018. Patients were stratified into two groups: those with and without chronic disease, defined as any patient with at least one of eight chronic health conditions. Inclusion criteria: patients seen in the PED ultimately diagnosed with sepsis or septic shock, patient age 0 to 20 years and time zero for identification of sepsis in the PED. Exclusion criteria: time zero unavailable, inability to determine time of first IVF or antibiotic administration or patient death within the PED. Primary analysis included comparison of time zero to first IVF and antibiotic administration between each group. Results: 312 patients met inclusion criteria. 169 individuals had chronic disease and 143 did not. Median time to antibiotics in those with chronic disease was 41.9 min versus 43.0 min in patients without chronic disease (p = 0.181). Time to first IVF in those with chronic disease was 22.0 min versus 12.0 min in those without (p = 0.010). Those with an indwelling line/catheter (n = 40) received IVF slower than those without (n = 272), with no significant difference in time to antibiotic administration by indwelling catheter status (p = 0.063). There were no significant differences in the mode of identification of suspected sepsis or septic shock between those with versus without chronic disease (p = 0.27). Conclusions: Study findings suggest pediatric patients with chronic disease with suspected sepsis or septic shock in the PED have a slower time to IVF administration but equivocal use of sepsis recognition tools compared to patients without chronic disease. (c) 2021 Elsevier Inc. All rights reserved.