Lorton et al evaluated the initial care given to pediatric patients with severe community-onset bacterial infection. Improved care can result in better outcomes and fewer sequelae. The authors are from multiple institutions in France.
Patient selection: pediatric patient with severe community-onset bacterial infection
Rate of suboptimal care initially: 34%
Care delivery was evaluated based on:
(1) delay in seeking care by family
(2) physician's assessment of severity
(3) referral of patient at first consultation with sign of severity
(4) timing of antibiotic therapy
(5) dose of antibiotic therapy
(6) time of fluid bolus administration
(7) volume of fluid bolus administration
(8) clinical reassessment after fluid bolus
Risk factors for suboptimal care:
(1) age < 5 years (aOR 3.2)
(2) sepsis with no source aOR( 5.8)
(3) meningitis (aOR 3.4)
(4) initial care by a primary care physician (aOR, 3.2, vs pediatric hospital)
Receipt of suboptimal care was associated with sequelae (aOR 5.6)
