Mortality and clinical outcomes in paediatric septic shock: a propensity-matched analysis before and after the implementation of an institutional guideline in single centre in Thailand.

Abstract

Paediatric septic shock is a life-threatening condition with high global morbidity and mortality rates. Prior guidelines for paediatric septic shock demonstrated varying levels of effectiveness. In 2017, the institutional paediatric septic shock guidelines were established, emphasizing three pivotal components: prompt recognition, early and appropriate resuscitation, and organ support with intensive stabilization. Herein, we aimed to assess the effect of paediatric septic shock guidelines on mortality and clinical outcomes. This single-centre retrospective cohort study investigating the pre- and postimplementation of paediatric septic shock guidelines was conducted in patients aged 1 month to 15 years diagnosed with septic shock from January 2014 to December 2022. The effectiveness of the guideline implementation was evaluated through propensity matching analysis to compare 30-day in-hospital mortality rates. Adherence to key components of the guidelines was also assessed. In total, 71 and 106 paediatric patients with septic shock were admitted to the paediatric intensive care unit during the pre- and postguideline periods, respectively. The postguideline group exhibited a significant reduction in mortality [adjusted odds ratio (aOR): 0.29, 95% confidence interval (CI): 0.12-0.71, P = .007] and a decrease in respiratory dysfunction (aOR: 0.40, 95% CI: 0.18-0.91, P = .03). Guideline adherence revealed a substantial increase in the use of peripheral inotropes and noninvasive cardiac monitoring. The number needed to treat for the protocol to prevent death was six. The implementation of the paediatric septic shock guidelines, emphasizing early shock recognition, prompt resuscitation, infection control, and appropriate organ management in intensive care, significantly improved outcomes.