Scholarlink

Background <p>Pediatric sepsis remains a leading cause of mortality in resource-limited settings. We evaluated the delivery of time-critical sepsis interventions and their association with in-hospital mortality among children in Tanzania.</p> Methods <p>We conducted a secondary analysis of a prospective cohort of children (28&#xa0;days to 14&#xa0;years) presenting with sepsis to the Emergency Medicine Department at Muhimbili National Hospital, Dar es Salaam, Tanzania (July 2022 to November 2024). Sepsis was defined as fever and at least one World Health Organization warning sign. Local pediatric sepsis guidelines recommend antibiotics and intravenous fluids (IVF) for all patients with sepsis, regardless of the source. Primary exposures were receipt and timing of antibiotics and IVF. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, nutritional status, referral status, and illness severity.</p> Results <p>Among 755 children, 61.2% (<i>n</i> = 462) received antibiotics, and 55.6% (<i>n</i> = 420) received IVF. Median time to intervention was 2.4&#xa0;h (IQR 1.6–3.7). 35.5% (<i>n</i> = 268) received both interventions, and only 3.7% (<i>n</i> = 28) received them within one hour. In-hospital mortality was 19.6% (<i>n</i> = 148), with a median time to death of 4.1&#xa0;days (IQR 1.6–9.5). In a multivariable analysis, time to initiation of both antibiotics and IVF was not significantly associated with in-hospital mortality (adjusted OR 1.29; 95% CI 0.83–2.0; <i>p</i> = 0.264). When modeled continuously, a longer time to IVF administration was associated with increased mortality risk (HR 1.05 per hour delay; 95% CI 1.01–1.10).</p> Conclusions <p>Receipt of time-critical sepsis interventions (antibiotics and IVF) was delayed and inconsistent, with no observed association with decreased mortality, although residual confounding may remain. This both highlights gaps in early evidence-based care delivery and suggests additional, system-related influences on pediatric sepsis outcomes. Our findings underscore the need for context-specific strategies to strengthen pediatric sepsis management in resource-limited settings.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Time-critical sepsis interventions and clinical outcomes among children in a tertiary Tanzanian emergency department

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月24日

查看全文
  • Abigail M. Sorensen,
  • Raya Y. Mussa,
  • Erasto M. Sunzula,
  • Victoria M. Mlele,
  • Scott P. Oltman,
  • Cecilia L. Msemwa,
  • Lushona K. Mathias,
  • Kathleen S. Sun,
  • Jazmin M. Baez-Maidana,
  • Juma A. Mfinanga,
  • Victoria T. Chu,
  • Anneka M. Hooft,
  • Namala P. Mkopi,
  • Joel P. Manyahi,
  • Teresa B. Kortz,
  • Hendry R. Sawe

摘要

Background

Pediatric sepsis remains a leading cause of mortality in resource-limited settings. We evaluated the delivery of time-critical sepsis interventions and their association with in-hospital mortality among children in Tanzania.

Methods

We conducted a secondary analysis of a prospective cohort of children (28 days to 14 years) presenting with sepsis to the Emergency Medicine Department at Muhimbili National Hospital, Dar es Salaam, Tanzania (July 2022 to November 2024). Sepsis was defined as fever and at least one World Health Organization warning sign. Local pediatric sepsis guidelines recommend antibiotics and intravenous fluids (IVF) for all patients with sepsis, regardless of the source. Primary exposures were receipt and timing of antibiotics and IVF. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, nutritional status, referral status, and illness severity.

Results

Among 755 children, 61.2% (n = 462) received antibiotics, and 55.6% (n = 420) received IVF. Median time to intervention was 2.4 h (IQR 1.6–3.7). 35.5% (n = 268) received both interventions, and only 3.7% (n = 28) received them within one hour. In-hospital mortality was 19.6% (n = 148), with a median time to death of 4.1 days (IQR 1.6–9.5). In a multivariable analysis, time to initiation of both antibiotics and IVF was not significantly associated with in-hospital mortality (adjusted OR 1.29; 95% CI 0.83–2.0; p = 0.264). When modeled continuously, a longer time to IVF administration was associated with increased mortality risk (HR 1.05 per hour delay; 95% CI 1.01–1.10).

Conclusions

Receipt of time-critical sepsis interventions (antibiotics and IVF) was delayed and inconsistent, with no observed association with decreased mortality, although residual confounding may remain. This both highlights gaps in early evidence-based care delivery and suggests additional, system-related influences on pediatric sepsis outcomes. Our findings underscore the need for context-specific strategies to strengthen pediatric sepsis management in resource-limited settings.