Pediatric Sepsis in Community Emergency Care Settings: Guideline Concordance and Outcomes

Abstract

Objectives: Bundled pediatric sepsis care has been associated with improved outcomes in tertiary pediatric emergency departments. Sepsis care at nontertiary sites where most children seek emergency care is not well described. We sought to describe the rate of guideline-concordant care, and we hypothesized that guideline-concordant care in community pediatric emergency care settings would be associated with decreased hospital length of stay (LOS).Method: This retrospective cohort study of children with severe sepsis presenting to pediatric community emergency and urgent care sites included children 60 days to 17 years with severe sepsis. The primary predictor was concordance with the American College of Critical Care Medicine 2017 pediatric sepsis resuscitation bundle, including timely recognition, vascular access, intravenous fluids, antibiotics, vasoactive agents as needed.

Decision-Making in the Pediatric Emergency Department—A Survey of Guidance Strategies among Residents

“…Higher awareness and preparation for critical pediatric situations result in lower mortality [ 2 ]. Time-sensitive and critical situations include anaphylaxis [ 3 ], burns [ 4 ], sepsis [ 5 ], shock [ 6 ], and choosing the right medication for various events [ 7 , 8 ]. Therefore, pediatric and pediatric surgery residents require fast and easy access to databases and may use the internet or specialized smartphone applications more often than established printed books.…”

Pediatric Septic Shock Care Pathways in General Emergency Departments

“…7 General hospital EDs are less likely to have implemented care pathways for pediatric sepsis and less likely to recognize and appropriately treat pediatric sepsis. [8][9][10][11] Importantly, mortality from pediatric sepsis is significantly higher among children presenting to a GED compared with those presenting to a PED. 12 The objective of this study is to better understand the clinical and electronic health record (EHR) workflows, resource structures, communication patterns, culture, and clinical decision making surrounding pediatric septic shock across PED and GED settings.…”

“…General hospital EDs may be less prepared to care for pediatric emergencies compared with PEDs, and barriers to guideline implementation significantly contribute to lower pediatric readiness 7 . General hospital EDs are less likely to have implemented care pathways for pediatric sepsis and less likely to recognize and appropriately treat pediatric sepsis 8–11 . Importantly, mortality from pediatric sepsis is significantly higher among children presenting to a GED compared with those presenting to a PED 12 …”