Prevalence, Characteristics, and Determinants of Suboptimal Care in the Initial Management of Community-Onset Severe Bacterial Infections in Children

Pediatric emergency 2024 updates

Most children receive emergency care by general emergency physicians and not in designated children's hospitals. There are unique considerations in the care of children that differ from the care of adults. Many management principles can be extrapolated from adult studies, but the unique pathophysiology of pediatric disease requires specialized attention and management updates. This article highlights ten impactful articles from the 2024 whose findings can improve the care of children in the Emergency Department (ED). These studies address pediatric cervical spine injury, resuscitation, infant fever, appendicitis, direct admissions, mental practice, and hypothermia.

Rapid Bacterial/Viral Infections Typing Strategy Using a Portable Dual-Channel Electrochemical Biosensor Based on One-Step Assembly of Immunomagnetic Beads

Amidst multiple epidemics, a rapid, sensitive, economical, and portable infection diagnosis strategy is crucial for primary medical care, particularly through the analysis of pathogen sources to determine appropriate antibiotic use. C-reactive protein (CRP) and serum amyloid A (SAA) are host-related biomarkers, and their combined detection can effectively distinguish between bacterial and viral infections, which holds great significance for the diagnosis of unknown pathogens. In this work, a portable dual-channel electrochemical biosensor based on a one-step assembly of immunomagnetic beads was proposed for the on-site combined detection of plasma CRP and SAA, which streamlined the operation and shortened the minimum detection time to less than 3 min. The biosensor exhibited excellent linearity in the detection of 3.125-1250 ng/mL CRP and 31.25-1250 ng/mL SAA, with detection limits of 0.91 and 12 ng/mL, respectively, falling within the clinically relevant reference range. Through simulated sample tests, the biosensor effectively distinguished between bacterial infection, viral infection, and healthy plasma samples. The actual sample tests demonstrated a high correlation and comparable medical value to enzyme-linked immunosorbent assay. Overall, this proposed strategy showed potential to aid in infection diagnosis and enable rapid combined detection of multiple biomarkers.

Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study

BACKGROUND

Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).

OBJECTIVE

To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.

METHODS

This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0-24%; moderate 25-74%; high 75-100%) according to: bolus volume of 10-20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.

RESULTS

63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10-20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).

CONCLUSIONS

This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.

TRIAL REGISTRATION NUMBER

NCT05066464.

Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study

OBJECTIVES

To describe the distribution, consequences and potential determinants of time to antibiotics administration in children with community-onset severe bacterial infections (COSBIs).

DESIGN

Secondary analysis of the available data from a prospective population-based study from 2009 to 2014.

SETTING

An administrative area in western France accounting for 13% of the national pediatric population.

PATIENTS

All children from 1 month to 16 years old admitted to a PICU or who died before admission and had a COSBI.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The time to antibiotics was divided into patient interval (from first signs of COSBI to the first medical consultation) and medical interval (from the first consultation to appropriate antibiotics administration). The association between the medical interval and child outcome was studied by a multinomial logistic regression model and the potential determinants of the patient and medical intervals were by a Cox proportional-hazards model. Of the 227 children included (median age 2.1 yr), 22 died (9.7%), and 21 (9.3%) had severe sequelae at PICU discharge. Median patient and medical intervals were 7.0 hours (interquartile range [IQR], 2.0-16.5 hr) and 3.3 hours (IQR, 1.1-12.2 hr), respectively. The last quartile of medical interval was not associated with death (adjusted odds ratio [aOR], 3.7; 95% CI, 0.8-17.5) or survival with severe sequelae (aOR, 1.3; 95% CI, 0.4-4.0) versus survival without severe sequelae. Patient interval was shorter in younger children (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.92-0.99), and medical interval was reduced when the first consultation was conducted in a hospital (aHR, 1.5; 95% CI, 1.1-2.0) versus outpatient medicine.

CONCLUSIONS

For children with COSBI, we found no significant association between medical interval and mortality or severe sequelae. An initial hospital referral could help reduce the time to antibiotics in COSBIs.