A Comparative Study of Nursing Practices and Outcomes of Care for Children with Sepsis Using Systemic Inflammatory Response Syndrome and Thammasat Pediatric Early Warning Scores Criteria and Thammasat University Hospital Pediatric Sepsis Screening Scores

Abstract

Sepsis is a life-threatening condition and a leading cause of morbidity and mortality in hospitalized children. Early recognition of sepsis and timely initiation of treatment can reduce complications and mortality. The Thammasat University Hospital pediatric sepsis protocol consists of a sepsis screening tool and pediatric sepsis guidelines based on the Surviving Sepsis Campaign Guidelines for Pediatrics. Clinical tools, such as the Systemic Inflammatory Response Syndrome (SIRS) criteria, combined with the Thammasat Pediatric Early Warning Scores (TPEWS), have long served as standard frameworks in pediatric sepsis screening and care escalation.    However, a new version of institution-specific screening tools, the Thammasat University Hospital Pediatric Sepsis Screening Score (TUH pediatric sepsis screening score), has been developed aiming at improving early detection. This retrospective comparative study aimed to evaluate nursing practice and clinical outcome associated with the use of SIRS plus TPEWS criteria versus the TUH pediatric sepsis screening score. The study applied the Donabedian Model of quality assessment, consisting of three components,which include 1) the structure component covering the original and new versions of sepsis screening protocol, 2) the process involving the actual activities, such as assessment of sepsis according to sepsis screening protocol and timely administration of antibiotic within one hour, and 3) the outcome dimension encompassing key clinical indicators, such as incidence of septic shock, sepsis-related mortality, and registered nurse satisfaction with the screening tools used.

Outcome data were collected using the original pediatric sepsis protocol, which included the SIRS criteria and the TPEWS from December 2020 to March 2022, and the new version of the TUH Pediatric Sepsis Screening Score from April 2022 to July 2023. Data were collected from the Electronic Medical Records (EMR) of a sample of pediatric patients at risk for sepsis who were admitted to the pediatric ward at Thammasat University Hospital. The sample was selected through purposive sampling. Inclusion criteria comprised pediatric patients with a fever and a body temperature  above 38.5 °C. Exclusion criteria were: 1) presentation with septic shock prior to hospital admission,2) incomplete or missing data, 3) family refusal or termination of treatment, and 4) being transferred to another healthcare facility. The researcher obtained patient medical records that met the inclusion criteria from the Information Technology Office at Thammasat University Hospital. The patient sample was categorized into two groups: 281 pediatric patients who received the original version of the pediatric sepsis protocol, and 514 pediatric patients who received the new version of the protocol.Nurse satisfaction with the pediatric sepsis protocol was assessed from 43 registered nurses. Inclusion criteria for the nurse participants: 1) a minimum of three years of experience in pediatric care, 2) prior experience with nursing practices under both the original and new versions of the pediatric sepsis protocol, and 3) willingness to participate in the study. The researcher collected data using questionnaires enclosed in an envelope and distributed directly to the selected nurse participants for self-completion. The research instruments included: the Pediatric Patient Data Recording Forms, the SIRS and TPEWS Assessment Form, the TUH Pediatric Sepsis Screening Score Assessment Form,the Nursing Care Documentation Forms, the Clinical Outcomes Assessment Form, the Nurse Demographic Data Recording Forms, and the Nurse Satisfaction with the Pediatric Sepsis Protocol Questionnaire. The content validity index (CVI) of all research instruments was equal to 1. The reliability coefficients of the satisfaction of nurses with the original version and the new version of the Pediatric Sepsis Protocol Questionnaire, as measured by Cronbach’s alpha, were .95 and .97,respectively. SPSS version 29 was used to analyze the data and determine statistical significance at .05. Data were analyzed using descriptive statistics, chi-square, Fisher’s exact test, independent t-tests, and paired t-tests.

The research findings revealed that the sepsis in pediatrics using the TUH pediatric sepsis screening score assessment and the administration of the antibiotic within one hour were significantly greater, but the rate of septic shock was significantly lower than using the SIRS plus TPEWS assessment (χ2 = 10.66, p < .05); the mortality from sepsis was not a significant difference (p > .05). Registered nurses reported significantly higher satisfaction both overall and across all dimensions when using the new version of the pediatric sepsis protocol than the original version (t = -5.50, p < .05). The findings of this study have significant implications for pediatric sepsis management. These results support the use of the TUH Pediatric Sepsis Screening Score as a more effective and user-friendly tool for early identification and management of pediatric sepsis in clinical practice.

Keywords: Mortality, Pediatric sepsis protocol, Pediatric sepsis nursing care, Sepsis, Septic shock