title: Adherence to PALS Sepsis Guidelines and Hospital Length of Stay.
abstract: OBJECTIVE
  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.
authors: Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. raina.paul@childrens.harvard.edu
authors: Raina
authors: R
authors: Paul
authors: Mark I
authors: MI
authors: Neuman
authors: Michael C
authors: MC
authors: Monuteaux
authors: Elliot
authors: E
authors: Melendez
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D061345:Early Medical Intervention; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D012772:Shock, Septic / Q000175:diagnosis / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents