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Year : 2018  |  Volume : 31  |  Issue : 1  |  Page : 14-21

Impact of pre-pediatric ICU management on prognosis of sepsis and septic shock at Alexandria University Children’s Hospital

Department of Pediatrics, Alexandria University, Alexandria, Egypt

Correspondence Address:
Amel A.A Mahfouz
Department of Pediatrics, Alexandria University, Alexandria 2164655
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AJOP.AJOP_9_18

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Background Pre-pediatric ICU (PICU) management in cases of severe sepsis and septic shock is an extremely important factor in the outcome of the patients. Pre-PICU management can also be the direct cause of better outcome of cases with severe sepsis and septic shock. Aim The purpose of this study was to evaluate the pre-PICU management in cases of severe sepsis and septic shock at Alexandria University Children’s Hospital and its association with the survival rate of the cases. Patients and methods A cross-sectional study was conducted on 40 patients during 12 months period at PICU of Alexandria University Children’s Hospital with the diagnosis of severe sepsis and/or septic shock. Their age ranged from 1 month to 12 years, 21 were males and 19 were females. All cases were subjected to history taking stressing on time from the start of illness until the patient arrived to the hospital, pre-referral treatment, number and kind of medical centers that took care of the patient before admission. The clinical condition of the patient on admission was evaluated (with respect to the degree of sepsis) and the mortality probability on admission was performed using Pediatric Index of Mortality 2 (PIM-2) score. Routine investigations were done at admission. Follow-up of the cases in PICU was evaluated by PIM-2 score, length of stay and the prognosis of cases whether improvement or death. Results Twenty-three (57.5%) cases presented with septic shock and 17 (42.5%) cases presented with severe sepsis. Gastrointestinal tract infection and chest infection were the most common clinical sources of sepsis (16 and 10 cases, respectively). The mean of the duration from start of illness until patient arrived to the hospital was 7 days in nonsurvivors versus 3 days in survivors. Eighteen (45%) patients did not receive any antibiotic therapy before admission, whereas 22 (55%) received antibiotics via different routes before admission. Conclusion The results indicated that gastrointestinal tract infections and chest infection were the most common clinical sources of sepsis. Administration of intravenous antimicrobial therapy with the onset of sepsis is an important factor in better prognosis of septic shock and PIM-2 score is a good predictor of mortality on the first day of admission to PICU. Referral from a tertiary hospital to PICU is a good indicator for better prognosis.

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