[Hospital epidemiology, management and outcome of pediatric sepsis and severe sepsis in 4 PICUs in Shanghai].
OBJECTIVE
Sepsis is a major healthcare problem in Pediatric intensive Care unit (PICU). Therapies administrated in the initial hours after sepsis develops are likely to influence outcome. To guide the bedside clinician to improve the outcomes, the Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock was updated in 2008. This study aimed to assess the presentation, severity of disease, intensive care outcome of patients with sepsis admitted to the PICU and evaluate the compliance of implementation of the Surviving Sepsis Campaign guidelines.


METHODS
Medical records of the patients treated for sepsis in PICUs of 4 hospitals including Children's Hospital of Fudan University, Shanghai Children's Medical Centre, Children's Hospital of Shanghai and Shanghai Xinhua Hospital from April 2008 to March 2009 were reviewed retrospectively. Doctors of the Critical Care Centre not involved in the clinical management analyzed the clinical charts and compared the treatment received and how the Surviving Sepsis Campaign implements.


RESULTS
1. Out of the 2100 patients admitted to the 4 PICUs from April 2008 to March 2009, 304 (14.48%) were diagnosed sepsis, among whom 212 (69.74%) children were sent to the PICU directly; 118 (38.8%) cases suffered from severe sepsis, 36 (30.51%) of whom died. Five (2.8%) cases died of sepsis, there was statistically significant difference (P < 0.01). The median age of the patients was 37 months. The sex ratio (M:F) was 1.95:1. The Pediatric Critical Illness Score on admission and the lowest score of the survivors were significantly higher than that of the dead cases. 2. All the children suffering from septic shock received fluid resuscitation, 22.95% of whom were inappropriate, including no enough fluid administration and too early vasopressor preference; 30% cases treated with vasopressor were not diagnosed septic shock, and no norepinephrine or epinephrine was administrated. Antibiotics were administrated in 181 (59.54%) cases within 1 hr of admission. Low-dose steroids therapy was given to 64 cases, 39 of whom did not suffer from severe sepsis or septic shock. A few cases were treated with insulin, heparin or continuous blood purification. 3. Of all the sepsis patients, 41 (13.5%) died. Thirty-six children (30.51%) with severe sepsis and 5 (2.80%) cases who did not suffer from severe sepsis died, which made significant difference (P < 0.01); 29 (29%) of 100 cases whose Pediatric Critical Illness Score was < 80 died, which was 70.73% of all the deaths, and 12 (5.88%) cases whose severity score was > 80 died, 29.27% of all the dead cases (P < 0.05). Of all the cases, 46 (15.1%) gave up treatment.


CONCLUSIONS
There is a high proportion of sepsis in patients admitted to the four PICUs in Shanghai. Children who have low Glasgow severity score or in their very young age have a higher mortality rate. The adherence to the Surviving Sepsis Campaign guidelines still needs to be improved.
D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy