现在的位置: 首页时讯速递, 进展交流>正文
[JAMA最新论文]:纽约全身性感染强制治疗措施与全身性感染患儿住院病死率的相关性
2018年08月05日 时讯速递, 进展交流 暂无评论

Original Investigation

July 24/31, 2018

Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis

Idris V. R. Evans, Gary S. Phillips, Elizabeth R. Alpern, et al

JAMA. 2018;320(4):358-367. doi:10.1001/jama.2018.9071

Abstract

Importance 背景

The death of a pediatric patient with sepsis motivated New York to mandate statewide sepsis treatment in 2013. The mandate included a 1-hour bundle of blood cultures, broad-spectrum antibiotics, and a 20-mL/kg intravenous fluid bolus. Whether completing the bundle elements within 1 hour improves outcomes is unclear.

一名全身性感染患儿的死亡促使纽约州要求自2013年起在全州范围内规范全身性感染的治疗。这一要求包括1小时集束化治疗措施,即血培养,广谱抗生素,以及静脉输液20 ml/kg。在1小时内完成上述集束化治疗措施能否改善预后尚不清楚。

Objective 目的

To determine the risk-adjusted association between completing the 1-hour pediatric sepsis bundle and individual bundle elements with in-hospital mortality.

确定完成全身性感染儿童1小时集束化治疗及各项措施与住院病死率之间的风险校正相关性。

Design, Settings, and Participants 设计、场景及研究人群

Statewide cohort study conducted from April 1, 2014, to December 31, 2016, in emergency departments, inpatient units, and intensive care units across New York State. A total of 1179 patients aged 18 years and younger with sepsis and septic shock reported to the New York State Department of Health who had a sepsis protocol initiated were included.

2014年4月1日至2016年12月31日间,纽约州范围内急诊科、住院病房及ICU进行的队列研究。共有1179名年龄不足18岁的全身性感染及感染性休克患儿接受了全身性感染的治疗,并向纽约州卫生署进行了报告。

Exposures 暴露因素

Completion of a 1-hour sepsis bundle within 1 hour compared with not completing the 1-hour sepsis bundle within 1 hour.

1小时内完成全身性感染1小时集束化治疗,与未在1小时内完成集束化治疗相比较。

Main Outcomes and Measures 主要预后指标

Risk-adjusted in-hospital mortality.

风险校正住院病死率

Results 结果

Of 1179 patients with sepsis reported at 54 hospitals (mean [SD] age, 7.2 [6.2] years; male, 54.2%; previously healthy, 44.5%; diagnosed as having shock, 68.8%), 139 (11.8%) died. The entire sepsis bundle was completed in 1 hour in 294 patients (24.9%). Antibiotics were administered to 798 patients (67.7%), blood cultures were obtained in 740 patients (62.8%), and the fluid bolus was completed in 548 patients (46.5%) within 1 hour. Completion of the entire bundle within 1 hour was associated with lower risk-adjusted odds of in-hospital mortality (odds ratio [OR], 0.59 [95% CI, 0.38 to 0.93], P = .02; predicted risk difference [RD], 4.0% [95% CI, 0.9% to 7.0%]). However, completion of each individual bundle element within 1 hour was not significantly associated with lower risk-adjusted mortality (blood culture: OR, 0.73 [95% CI, 0.51 to 1.06], P = .10; RD, 2.6% [95% CI, −0.5% to 5.7%]; antibiotics: OR, 0.78 [95% CI, 0.55 to 1.12], P = .18; RD, 2.1% [95% CI, −1.1% to 5.2%], and fluid bolus: OR, 0.88 [95% CI, 0.56 to 1.37], P = .56; RD, 1.1% [95% CI, −2.6% to 4.8%]).

54所医院共报告1179名全身性感染患儿(平均 [SD] 年龄,7.2 [6.2] 岁;男性,54.2%;既往健康 44.5%;诊断为休克,68.8%),其中139名 (11.8%) 死亡。294 名患儿 (24.9%) 在1小时内完成了所有全身性感染集束化治疗。在1小时内,798 名患儿 (67.7%)使用了抗生素,740 名患儿 (62.8%) 留取了血培养,548 名患儿 (46.5%) 完成了快速补液。1小时内完成所有集束化治疗措施伴随较低的风险校正住院病死率(比数比 [OR], 0.59 [95% CI, 0.38 to 0.93], P = .02; 预计风险差异 [RD], 4.0% [95% CI, 0.9% to 7.0%])。然而,1小时内完成各个单项措施并不伴随风险校正病死率降低(血培养:OR, 0.73 [95% CI, 0.51 to 1.06], P = .10; RD, 2.6% [95% CI, −0.5% to 5.7%]; 抗生素:OR, 0.78 [95% CI, 0.55 to 1.12], P = .18; RD, 2.1% [95% CI, −1.1% to 5.2%], 快速补液: OR, 0.88 [95% CI, 0.56 to 1.37], P = .56; RD, 1.1% [95% CI, −2.6% to 4.8%])。

Conclusions and Relevance 结论

In New York State following a mandate for sepsis care, completion of a sepsis bundle within 1 hour compared with not completing the 1-hour sepsis bundle within 1 hour was associated with lower risk-adjusted in-hospital mortality among patients with pediatric sepsis and septic shock.

纽约州对全身性感染治疗提出要求后,对于罹患全身性感染和感染性休克的患儿,1小时内完成全身性感染集束化治疗伴随风险校正住院病死率降低。

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博