Clinical profile and outcome of septic shock in children admitted to a tertiary care referral hospital

Abstract

Background: There is dearth of studies on detailed clinical profile and outcome of pediatric septic shock in India. Objective: To describe clinical profile and outcome of septic shock in children. Methods: This retrospective study was conducted from June 2010 to June 2013 in a tertiary care hospital. Case records of children aged 1month to 18 years with diagnosis of septic shock were analyzed. Results: A total of 94(9%) out of 1035 admissions had shock and 53(56.3%) of them had a diagnosis of septic shock. Analysis was done on 43 (M:F, 20:23). The mean age was 3 year (range 1month–14 years). Maximum (48.83%) cases were in infancy. The common presenting symptom was fever (62.79%) followed by altered mental status in 30.23%. Pediatric SIRS criteria was met in 35(81.3%). Most common abnormal lab parameters were elevated liver enzymes (86.04%) followed by anemia (62.79%) and leukocytosis (60.46%). Thrombocytopenia and Coagulopathy was seen in 55.81% and 60.41% respectively. Pneumonia was the commonest etiology (51.1%) followed by cellulitis/abscess in 30.2%. Blood culture was positive in 18.6% and Staphylococcus was the commonest organism. Frequency of MODS was 90.69%. Most (74.41%) cases presented with decompensated shock and 97.67% required inotropes. Majority (88.37%) required mechanical ventilation. The mortality rate was 60.46% and mean duration of PICU was 8.3 days. Anemia, leucopenia, decompensated shock and need for mechanical ventilation were significantly associated with mortality (p<0.05). Conclusion: Septic shock was the most common type of shock encountered in PICU and carries a high mortality. Maximum numbers of patients were below 1year and pneumonia was the commonest underlying cause.