Prevalence and Management of Septic Shock Among Children Admitted at the Kenyatta National Hospital

Abstract

Paediatric septic shock is a major cause of morbidity and mortality in all parts of the world mainly due to acute haemodynamic compromise. Early recognition and early goal directed therapy recommended by Surviving Sepsis Guideline and World Health Organization guidelines have been shown to reduce mortality. Locally the prevalence and outcome of septic shock is unknown. Audit of septic shock management will improve our care for children, improve gaps in knowledge and clinical skills, provide the basis of development of septic shock guidelines and septic shock tool kits for use in emergency care department Study objective The primary objectives of this study were to determine the prevalence and to audit the management of septic shock among children aged 0 days to 12 years admitted at the Kenyatta National Hospital. The secondary objective was to determine the outcome of septic shock within 72 hours of admission. Methods This was a hospital based longitudinal survey carried out over 2 months (September – October 2016) among children aged 0 days to 12 years admitted at the Kenyatta National Hospital. Consecutive sampling was done and all children who met the inclusion criteria being admitted were enrolled in the study. An informed consent was obtained for all participants enrolled in the study. A standard questionnaire was used for data collection. Data was stored in MS-EXCEL and analysed using STATA 12. Results The prevalence of paediatric septic shock among 325 children admitted at KNH was 15.4%, with median age of 4 months (IQR=0.5-9months). Neonates had the highest prevalence 25.6% of septic shock. Odds of being admitted with septic shock reduced with increase in age and no child was diagnosed with septic shock above 60 months of age. Male: female ratio was 1:1.8. All children were admitted with cold shock. Hypotension was present in 56% of the children. Septic shock was recognized in only 56% children by the attending clinician at KNH. All children with

septic shock were in fluid refractory shock. Optimum care was provided as per the surviving Sepsis guidelines in 0%, 6.5% and 20% children at 1st, 24 and 48 hours respectively. The mortality was 70% in 72 hours of admission with 54% dying within first 24 hours. Infants had the highest case fatality of 82.6%. Unavailability of mechanical ventilation in the 1st hour of recognition of shock was associated with high mortality (p value= 0.04). Hypotension on admission was associated with high mortality (p value=0.002). Conclusion The prevalence rate of septic shock is 15.4% among children aged 0-12 years admitted at KNH. Septic shock was recognized by the attending clinician 56% of the patients admitted with septic shock. Optimal care as per the Surviving Sepsis Guidelines was a challenge at KNH due to limited intensive care resources and no child received full care in the golden hour. The mortality among children with septic shock was 70% at 72 hours of admission. Recommendations Early recognition and management of septic shock requires continues training of health care workers to create awareness and improve care. There is need to include septic shock management guidelines in our local Kenyan paediatric guidelines, to improve management and outcome among children diagnosed with septic shock.