A Quality Improvement Intervention for the Initial Care of Pediatric Septic Shock in a Resource-Limited Setting
2
Issued Date
2025-09-01
Resource Type
ISSN
29505410
Scopus ID
2-s2.0-105013482283
Journal Title
Journal of Pediatrics Clinical Practice
Volume
17
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Pediatrics Clinical Practice Vol.17 (2025)
Suggested Citation
Phumeetham S., Limprayoon K., Law S., Preeprem N., Kriengsoontornkij W. A Quality Improvement Intervention for the Initial Care of Pediatric Septic Shock in a Resource-Limited Setting. Journal of Pediatrics Clinical Practice Vol.17 (2025). doi:10.1016/j.jpedcp.2025.200170 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111778
Title
A Quality Improvement Intervention for the Initial Care of Pediatric Septic Shock in a Resource-Limited Setting
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Corresponding Author(s)
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Abstract
Objective: To evaluate the effectiveness of a quality improvement protocol-driven bundle care approach in reducing 28-day mortality among children with septic shock in a resource-limited setting. Study design: We conducted a retrospective-prospective observational study in a pediatric intensive care unit from January 2013 to August 2023. Clinical data were collected during the preprotocol and postprotocol periods. The primary outcome was 28-day mortality. The impact of a protocol-driven bundle care approach on 28-day mortality was assessed using multivariate logistic regression analysis. Results: We studied 163 patients: 94 in the preprotocol period and 69 in the postprotocol period. The median age was 8.5 years (IQR 1.9-13.5), and the median Pediatric Risk of Mortality, version III (PRISM-III) score was 11 (IQR 5-18). After protocol implementation, 28-day mortality significantly decreased from 32.9% to 11.6% (P = .002). There was no difference in illness severity between the groups. Multivariate logistic regression analysis revealed that patients cared for in the postintervention period had a significantly decreased risk of 28-day mortality (aOR 0.258, 95% CI 0.086-0.770, P = .015). However, higher PRISM-III scores were independently associated with increased mortality (aOR 1.193, 95% CI 1.115-1.277, P < .001). Conclusions: Implementing a quality improvement protocol-driven bundle care approach in a resource-limited pediatric setting was independently associated with a reduction in 28-day mortality among children with septic shock. These findings support the adoption of evidence-based protocols to improve outcomes in environments with limited resources. The strong correlation between PRISM-III scores and mortality highlights the importance of early recognition and planning for effective, timely intervention, and resource allocation.