dc.description.abstract |
Background: Pediatric sepsis causes significant global morbidity and mortality and
low- and middle-income countries (LMICs) bear the bulk of the burden. International
sepsis guidelines may not be relevant in LMICs, especially in sub-Saharan Africa
(SSA), due to resource constraints and population differences. There is a critical lack
of pediatric sepsis data from SSA, without which accurate risk stratification tools and
context-appropriate, evidence-based protocols cannot be developed. The study’s
objectives were to characterize pediatric sepsis presentations, interventions, and out-
comes in a public Emergency Medicine Department (EMD) in Tanzania.
Methods: Prospective descriptive study of children (28 days to 14 years) with sepsis
[suspected infection with ≥2 clinical systemic inflammatory response syndrome (SIRS)
criteria] presenting to a tertiary EMD in Dar es Salaam, Tanzania (July 1 to September 30,
2016). Outcomes included: in-hospital mortality (primary), EMD mortality, and hospital
length of stay. We report descriptive statistics using means and SDs, medians and inter-
quartile ranges, and counts and percentages as appropriate. Predictive abilities of SIRS
criteria, the Alert-Verbal-Painful-Unresponsive (AVPU) score and the Lambaréné Organ
Dysfunction Score (LODS) for in-hospital, early and late mortality were tested.
results: Of the 2,232 children screened, 433 (19.4%) met inclusion criteria, and 405 were
enrolled. There were 247 (61%) subjects referred from an outside facility. Approximately
half (54.1%) received antibiotics in the EMD, and some form of microbiologic culture
was collected in 35.8% (n = 145) of subjects. In-hospital and EMD mortality were 14.2
and 1.5%, respectively, median time to death was 3 days (IQR 1–6), and median length
of stay was 6 days (IQR 1–12). SIRS criteria, the AVPU score, and the LODS had low
positive (17–27.1, 33.3–43.9, 18.3–55.6%, respectively) and high negative predictive
values (88.6–89.8, 86.5–91.2, 86.8–90.5%, respectively) for in-hospital mortality.
CONCLUSION: This pediatric sepsis cohort had high and early in hospital mortality. current criteria and tested clinical scores were inadequate for risk-stratification and mortality prediction in this population and setting. Pediatric sepsis management must take into account the local patient population, etiologies of sepsis, healthcare system, and resource availability. Only through studies such as this that generate regional data in LMCs can accurate risk stratification tools and context-appropiate, evidence-based guidelines be developed |
en_US |