脓毒症重症监护儿童的死亡时间:2005-2011年与2018-2023年英国两个队列的比较

IF 4.5 2区 医学 Q1 CRITICAL CARE MEDICINE
Maile Wedgwood, Elise Randle, Maik Honsel, Padmanabhan Ramnarayan, Mark J Peters
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引用次数: 0

摘要

目的:回顾2018-2023年重症监护室脓毒症患儿的死亡时间,并与我院2005-2011年的实践进行比较。我们假设大多数死亡发生在转至PICU的24小时内,其中许多发生在PICU入院之前。设计、环境和患者:我们回顾了2018年1月至2023年3月期间转介到英国北泰晤士地区儿童重症监护运输服务中心(CATS)的病例。我们纳入了诊断为“败血症”、“严重败血症”、“败血症”或“感染性休克”的儿童(小于16岁)。主要结局指标是转诊后至死亡时间长达一年。测量和主要结果:在62个月的研究期间,有11,231例转诊到CATS,其中330例(3%)符合研究纳入标准。结果数据为272例,其中29例(11%)在转诊后的第一年死亡,这与我们2005-2011年同一服务的队列比较有利,其中1年死亡率为21%(130/627):平均差异为10% (95% CI, 4.8% -14.6%), p值= 0.0003。29例死亡中有18例发生在转诊后的头24小时内。在患有合并症的儿童中,139例中有12例(9%)死亡,而133例健康儿童中有6例(5%)死亡(p = 0.22, Fisher精确检验,优势比[OR] 2.0, 95% CI, 0.73-5.5)。到1年时,患有合并症儿童的死亡率为139 / 19(13.9%),而先前健康儿童的死亡率为133 / 10 (7.5%)(p = 0.12; OR为1.8 [95% CI, 0.82-4.1])。结论:2018-2023年,临床诊断为“败血症”的PICU取出的转诊比例较低,为3%。与我们2005-2011年的队列一样,大多数死亡发生在首次转诊后24小时内。因此,早期识别和复苏仍然是改善败血症预后的最大潜力,这对临床试验具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Timing of Death in Children Referred for Intensive Care With Sepsis: Comparison of Two Cohorts in the United Kingdom, 2005-2011 vs. 2018-2023.

Objective: To review the timing of death in children with sepsis referred for intensive care, 2018-2023, and compare with our previous 2005-2011 practice. We hypothesized that most deaths occur within 24 hours of referral to the PICU, with many before PICU admission.

Design, setting, and patients: We reviewed referrals to the Children's Acute Transport Service (CATS), North Thames regional pediatric intensive care transport service in the United Kingdom, between January 2018 and March 2023. We included referrals of children (younger than 16 yr) with a working diagnosis of "sepsis," "severe sepsis," "septicemia," or "septic shock." The primary outcome measure was time to death up to a year after referral.

Measurements and main results: Over the 62-month study period, 11,231 referrals were made to CATS, and 330 (3%) met the study inclusion criteria. Outcome data were available on 272, of whom 29 (11%) died in the first year after referral, which compares favorably with our 2005-2011 cohort from the same service in which the 1-year mortality was 21% (130/627): mean difference 10% (95% CI, 4.8-14.6%), p value equals 0.0003. Eighteen of the 29 deaths occurred in the first 24 hours after referral. Amongst children with comorbidities 12 of 139 (9%) died compared to 6 of 133 (5%) previously healthy children (p = 0.22 Fisher exact test, odds ratio [OR] 2.0 with 95% CI, 0.73-5.5). By 1 year, mortality in children with comorbidities was 19 of 139 (13.9%) vs. mortality in previously healthy children of 10 of 133 (7.5%) (p = 0.12; OR 1.8 [95% CI, 0.82-4.1]).

Conclusions: In 2018-2023, the proportion of referrals for PICU retrieval with a clinical diagnosis of "sepsis" was low at 3%. As with our 2005-2011 cohort, most deaths occurred within 24 hours of first referral. Therefore, early recognition and resuscitation still have the greatest potential for improving sepsis outcomes, which has implications for clinical trials.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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