What follows below is from *An Emergency Department Septic Shock Protocol and Care Guideline for Children Initiated at Triage:
abstractBACKGROUND: Unrecognized and undertreated septic shock increases morbidity and mortality. Septic shock in children is defined as sepsis and cardiovascular organ dysfunction, not necessarily with hypotension.OBJECTIVE: Cases of unrecognized and undertreated septic shock in our emergency department (ED) were reviewed with a focus on (1) increased recognition at triage and (2) more aggressive treatment once recognized. We hypothesized that septic shock protocol and care guideline would expedite identification of septic shock, increase compliance
with recommended therapy, and improve outcomes.METHODS: We developed an ED septic shock protocol and care guideline to improve recognition beginning at triage and evaluated all eligible ED patients from January 2005 to December 2009.RESULTS: We identified 345 pediatric ED patients (49% male, median age: 5.6 years), and 297 (86.1%) met septic shock criteria at triage. One hundred ninety-six (56.8%) had 1 chronic complex condition. Hypotensionwas present in 34% (n 120); the most common findings were tachycardia (n 251 [73%]) and skin-color changes (n 269 [78%]). The median hospital length of stay declined over the study period (median: 181–140 hours; P .05); there was no change in mortality rate, which averaged 6.3% (22 of 345). The greatest gains in care included more complete recording of triage vital signs, timely fluid resuscitation and antibiotic administration, and serum lactate determination.CONCLUSIONS: Implementation of an ED septic shock protocol and care guideline improved compliance in delivery of rapid, aggressive fluid resuscitation and early antibiotic and oxygen administration and was associated with decreased length of stay.
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*An Emergency Department Septic Shock Protocol and Care Guideline for Children Initiated at Triage
PEDIATRICS Vol. 127 No. 6 June 1, 2011
The above article had been cited 10 times in PubMed at the time of access (5-11-205)
Cited In for PubMed (Select 21576304) [Link is to the PubMed page listing all of the articles below.
1. Time to first antimicrobial administration after onset of sepsis in critically ill children. Fusco NM, Parbuoni KA, Morgan JA. J Pediatr Pharmacol Ther. 2015 Jan-Feb;20(1):37-44. doi: 10.5863/1551-6776-20.1.37. PMID: 25859169 Free PMC Article Related citations
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7. Paediatric community-acquired septic shock: results from the REPEM network study.Van de Voorde P, Emerson B, Gomez B, Willems J, Yildizdas D, Iglowstein I, Kerkhof E, Mullen N, Pinto CR, Detaille T, Qureshi N, Naud J, De Dooy J, Van Lancker R, Dupont A, Boelsma N, Mor M, Walker D, Sabbe M, Hachimi-Idrissi S, Da Dalt L, Waisman H, Biarent D, Maconochie I, Moll H, Benito J. Eur J Pediatr. 2013 May;172(5):667-74. doi: 10.1007/s00431-013-1930-x. Epub 2013 Jan 26.PMID:23354787Free PMC ArticleRelated citations
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10. Prevention of sepsis in children: a new paradigm for public policy. Riley C, Wheeler DS.Crit Care Res Pract. 2012;2012:437139. doi: 10.1155/2012/437139. Epub 2011 Dec 18. PMID:22216408 Free PMC Article Related citations