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Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit
  1. D P Inwald1,
  2. R C Tasker2,
  3. M J Peters3,
  4. S Nadel4
  1. 1
    Department of Paediatrics, Faculty of Medicine, Imperial College London, London, UK
  2. 2
    Department of Paediatrics, University of Cambridge Clinical School, Addenbrooke’s Hospital, Cambridge, UK
  3. 3
    Critical Care Group, Portex Unit, Institute of Child Health, London, UK
  4. 4
    Paediatric Intensive Care Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Dr Inwald, Department of Paediatrics, Faculty of Medicine, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK; D.Inwald{at}imperial.ac.uk

Abstract

Objective: To audit current UK practice of the management of severe sepsis in children against the 2002 American College of Critical Care Medicine/Pediatric Advanced Life Support (ACCM-PALS) guideline.

Design: Prospective observational study.

Setting: 17 UK paediatric intensive care units (PICUs) and two UK PICU transport services.

Participants: 200 children accepted for PICU admission within 12 h of arrival in hospital, whether or not successfully transported to a PICU, with a discharge diagnosis of sepsis or suspected sepsis.

Main outcome measures: Medical interventions, physiological and laboratory data to determine the presence or absence of shock, inter-hospital transfer times, predicted mortality (using the Paediatric Index of Mortality, version 2 (PIM2) scoring system) and observed mortality.

Results: 34/200 (17%) children died following referral. Although children defined as being in shock received significantly more fluid (p<0.001) than those who were not in shock, overall fluid and inotrope management suggested by the 2002 ACCM-PALS guideline was not followed in 62% of shocked children. Binary logistic regression analysis demonstrated that the odds ratio for death, if shock was present at PICU admission, was 3.8 (95% CI 1.4 to 10.2, p = 0.008).

Conclusions: The presence of shock at PICU admission is associated with an increased risk of death. Despite clear consensus guidelines for the emergency management of children with severe sepsis and septic shock, most children received inadequate fluid resuscitation and inotropic support in the crucial few hours following presentation.

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Footnotes

  • Competing interests: None.

  • Funding: This study was supported by grants from the Paediatric Intensive Care Society and Children of St Mary’s Intensive Care. Dr Inwald is also grateful for support from the NIHR Biomedical Research Centre funding scheme. The funding agencies had no role in study design, data management, analysis or manuscript preparation.

  • Dr Inwald is guarantor.

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