Optimizing Resuscitation Care for Children with Sepsis: a Methods-Focused Pilot Study
CCCF ePoster library. Parker M. Oct 2, 2017; 198184
Dr. Melissa Parker
Dr. Melissa Parker
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Optimizing Resuscitation Care for Children with Sepsis: a Methods-Focused Pilot Study

Parker, Melissa1-5; Aguirre, Emilio1; Kam, April1,4,6; Pernica, Jeff1,4,7; Bailey, Karen4,8; Welsford, Michelle9; Kissoon, Niranjan10; Thabane, Lehana3,11; Fox-Robichaud, Alison9; Choong, Karen1-4

1Department of Pediatrics, McMaster University, Hamilton, Canada; 2Division of Pediatric Critical Care, McMaster University, Hamilton, Canada; 3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; 4McMaster Children’s Hospital, Hamilton, Canada; 5Division of Emergency Medicine, Hospital for Sick Children, Toronto, Canada; 6Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Canada; 7Division of Pediatric Infectious Diseases, McMaster University, Hamilton, Canada; 8Department of Pediatric Surgery, McMaster University, Hamilton, Canada; 9Department of Medicine, McMaster University, Hamilton, Canada; 10Department of Pediatrics, University of British Columbia, and Child and Family Research Institute; and BC Children’s Hospital and Sunny Hill Health Centre for Children; 11Biostatistics Unit,/FSORC, St Joseph's Healthcare Hamilton, Hamilton, Canada

INTRODUCTION:  Children with sepsis frequently receive suboptimal resuscitative interventions. Continuous quality improvement programs can be used to improve healthcare system performance, however the population and performance metrics of interest must be clearly defined. Measuring and monitoring sepsis care quality is challenging due to controversies surrounding sepsis definitions and variable methods by which cohort members are identified.
OBJECTIVES: We sought to conduct a methods-focused pilot study to determine the most feasible and robust screening method for sepsis case identification.
METHODS: Design: Prospective observational pilot study. Setting: McMaster Children’s Hospital (MCH). Participants: Children 0-17 yrs age with suspected or confirmed infection plus organ dysfunction. Timeframe: 12-month period (01/07/2015-30/06/2016). Screening methods: Two different screening methods were prospectively deployed to identify sepsis cases in children hospitalized during the study period. Method A entailed screening medical records of children who were either i) admitted to the Pediatric Critical Care Unit (PICU), ii) received a Medical Emergency Response Team (MET) activation, and/or iii) died in hospital. Method B entailed screening records identified based on a broad array of administrative diagnostic (International Classification of Disease 10) codes suggestive of a potential diagnosis of sepsis. While prospectively deployed, Method B could only identify cases post-discharge after ICD-10 code assignment. Potential cases (events) identified by Method A and/or Method B were assessed according study eligibility criteria to determine whether formal case criteria were met. Ethics: Study conduct was approved by the Hamilton Integrated Research Ethics Board (Project #15-333). Data: Demographic, treatment and laboratory data were abstracted from medical records and entered into the REDCap database. Analysis: A flow diagram was generated to depict study entry. Primary outcome analysis was performed by calculating case detection rates (cases/yr) for the two methods assessed.
RESULTS: During the study period 9523 children were admitted to MCH (excluding NICU admissions), of which 825 were admitted to the PICU. We identified 156 sepsis events in 143 unique individuals. Children were aged 63 +/- 65 months, 80/156 (51%) were male, and 96/156 (62%) had comorbidities. Method A identified 129 sepsis events (129/yr) by screening 228 records while Method B detected 131 sepsis events (131/yr) by screening of 1739 records. Although the majority of sepsis events 104/156 (67%) were identified by both Method A and Method B, 25/156 (16%) of events were identified exclusively by Method A and 27/156 (17%) of events were identified exclusively by Method B. International Consensus Conference Definitions (Goldstein Criteria) for sepsis were met for 85/156 (54%) of events. There was a trend toward a higher proportion of Goldstein Criteria positive events identified by Method A (78/85; 50%) vs. Method B (69/85; 44%).
CONCLUSION: We compared two methods for sepsis case identification and while case detection rates were roughly equal, Method A required screening fewer records and was able to identify events closer to their occurrence. Nearly an equal number of sepsis events were missed by Method A and Method B suggesting that use of either method in isolation may not be ideal. Further research is needed to refine screening and eligibility criteria for sepsis cohorts.

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