A Quality Improvement Intervention for the Initial Care of Pediatric Septic Shock in a Resource-Limited Setting

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.