Feasibility and efficacy of sepsis management guidelines in a pediatric intensive care unit in Saudi Arabia: a quality improvement initiative

Prevalence of pediatric sepsis in hospitalized children of Maiwand Teaching Hospital, Kabul, Afghanistan

BACKGROUND

Sepsis is a clinical syndrome associated with a systemic reaction to infection that is seen as a bacteremia with systemic symptoms. Sepsis is one of the most important problems in children and is associated with many deaths, so recognizing this disease and it's causing factors and identifying the predisposing factors for it is of great importance. Globally, the prevalence and occurrences of sepsis and septic shock are increasing, while the incidence of deaths from them has decreased with the improvement of diagnostic and treatment facilities. According to a 2015 World Health Organization report, approximately 5.9 million children under 5 years old have lost their lives due to sepsis worldwide, the majority of which have occurred in developing countries.

METHODS

This study was conducted in the pediatric department of Maiwand Teaching Hospital (MTH) in 2020 as a descriptive cross-sectional study. All children who were admitted to the pediatric department of Maiwand Teaching Hospital during 2020 were included in the research. Among them, the prevalence of sepsis in children with respect to age and sex was studied. The study included children over the age of 28 days who were admitted to the Maiwand Teaching Hospital pediatrics department in 2020. However, in this study, patients have been categorized into five categories according to age: less than two months, two months to one year, one to three years, three to five years old, and older than five years old.

RESULTS

This study was conducted in the pediatric department of Maiwand Teaching Hospital in 2020 as a descriptive cross-sectional study, and it was found that the prevalence of sepsis in children who were admitted to the pediatric department at this year was 50.5%, including the highest prevalence in males (65.75%) and at the age of two months to one year (37.9%). In this study, it was found that the prevalence of sepsis was higher (88.46%) among urban children than children who were living in villages (11.53%). In this study, the mortality rate was 2.44% for patients admitted to Maiwand Teaching Hospital.

CONCLUSIONS

In this study, it was found that the prevalence of sepsis was 50.5% in children admitted to the pediatrics department of Maiwand Teaching Hospital, of whom 67.75% were boys, 37.94% were aged two months to three years old, and it was more prevalent (88.46%) among children living in cities. The mortality rate was 2.44%.

Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia

Background

Pediatric sepsis remains a significant cause of morbidity and mortality worldwide. This study aimed to identify the incidence of sepsis and septic shock among patients admitted to the pediatric intensive care unit (PICU) of a tertiary center in Saudi Arabia.  Patients' demographics and risk factors associated with sepsis-related mortality were also investigated.

Methods

A retrospective cohort study was conducted in the PICU of King Abdulaziz Medical City, Jeddah (KAMC-J). KAMC-J is a tertiary care hospital in the western region of Saudi Arabia. A total of 2389 patients admitted to the PICU of KAMC-J between January 1, 2013 and December 31, 2017 were screened and evaluated for sepsis using The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Results

Of the 2389 total admissions to the PICU, 113 patients (4.9%) met the definition of Sepsis-3; 50.4% of the 113 patients met the definition of septic shock. Most patients (66.3%) were less than 6 years old, and 52.2% were male. Eight-five patients (75.2%) had underlying comorbidities. The respiratory system was the most common primary site of infection (57.5%). Bacterial and viral infections were the most common infectious etiology with reported rates of 29.2 and 21.2%, respectively. The median duration of PICU stay was 8 days and the 28-day PICU mortality rate was 23.9%. A Pediatric Sequential Organ Failure Assessment (pSOFA) Score greater than four and a pre-existing percutaneous central venous catheter were associated with a significant increase in mortality, with adjusted odds ratios of 3.6 (95% confidence interval: 1.30–9.93) and 9.27 (95% confidence interval: 1.28–67.29), respectively.

Conclusions

The incidence of sepsis in our institution is comparable to that reported internationally; however, the mortality rate is higher than that of developed countries. Nationwide studies identifying sepsis epidemiology are needed to improve the outcome of pediatric sepsis. Following international guidelines for central-line insertion and maintenance is of paramount importance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02686-0.

Association of Antibiotics Administration Timing With Mortality in Children With Sepsis in a Tertiary Care Hospital of a Developing Country

Objective: To investigate the association between antibiotics administration timing with morbidity and mortality in children with severe sepsis and septic shock, presenting to a tertiary care center in a developing country. Methods: This is a retrospective study of children aged 14 years or younger diagnosed with severe sepsis or septic shock at a free-standing tertiary children's hospital in Saudi Arabia between April 2015 and February 2018. We investigated the association between antibiotic administration timing and pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), hospital LOS, and ventilation-free days after adjusting for confounders. Results: Among the 189 admissions, 77 patients were admitted with septic shock and 112 with severe sepsis. Overall, the mortality rate was 16.9%. The overall median time from sepsis recognition to antibiotic administration was 105 min (IQR: 65-185.5 min); for septic shock patients, it was 85 min (IQR: 55-148 min), and for severe sepsis, 130 min (IQR: 75.5-199 min). Delayed antibiotic administration (> 3 h) was associated with 3.85 times higher PICU mortality (95% confidence intervals 1.032-14.374) in children with septic shock than in children who receive antibiotics within 3 h, after controlling for severity of illness, age, comorbidities, and volume resuscitation. However, delayed antibiotics administration was not significantly associated with higher PICU mortality in children diagnosed with severe sepsis. Conclusions: Delayed antibiotics administration in children with septic shock admitted to a free-standing children's hospital in a developing country was associated with PICU mortality.

Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region

RATIONALE, AIMS, AND OBJECTIVES

Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program.

METHODS

Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed.

RESULTS

In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs.

CONCLUSION

This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.

Satisfaction and perceived usefulness with newly-implemented Electronic Health Records System among pediatricians at a university hospital

BACKGROUND

Apposite implementation of Electronic Health Records (EHR) is anchoring standards of care in healthcare settings by reducing long-run operational costs, improving healthcare quality, and enhancing patient safety.

OBJECTIVE

This study aims to explore factors that might influence Pediatricians' satisfaction with an implemented EHR system and its perceived usefulness at a tertiary-care teaching hospital, Riyadh, Saudi Arabia.

METHODS

A cross-sectional survey distributed to all physicians working in the pediatric department of King Saud University Medical City (KSUMC) in the period from June to November 2015, two months after the launch of the EHR system, internally branded as electronic system for integrated health information (eSiHi). Bivariate and multivariate regression were analyzed to examine factors associated with physicians' satisfaction.

RESULTS

Of the 112 physicians who completed the survey, 97 (86.6%) attended training courses before the implementation of new EHR. On average, the participants rated the perceived usefulness of the new system at 6.4/10 for patient care and physicians' satisfaction levels were 5.2/10. The top indicator of EHR usefulness was the system's ability to reduce errors and improve the quality of care [mean 3.31, SD 0.9, RII 82.8%]; the lowest-ranking indicator was the physicians' perceived familiarity with functions and benefits [mean 2.68, SD 0.7, RII 67%]. The top indicator of satisfaction with the EHR system was enhanced "individual performance" [mean 3.04, SD 1, RII 60.9%]; the lowest-ranking perceived indicator was the limited availability of workplace computers [mean 1.91, SD 1.2, RII 38.2%].

CONCLUSIONS

Limited data regarding EHR implementation and end-users satisfaction in the Middle East region necessitates further work on factors affecting levels of satisfaction with the EHR system among different health institutes. Lack of information technology (IT) support, hardware, and time-consuming data entry process are challenging barriers for proper utilization of EHR for pediatric health care services.