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Войти в исследования Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2026
Pediatric Emergency Department Care for Septic Shock in Sub-Saharan Africa: Single-Center Outcomes Before-Vs.-After Implementation of a Telesimulation Program, 2023-2024.
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Denny Vanessa C, Amisah Justicia, Appiah John Adabie, Woods-Hill Charlotte Z, Wolfe Heather A, Nettey Gustav, Acheampong Princess R, Owusu Larko, Cassidy Kyle, Sanseau Elizabeth, Zhang Bingqing, James Ebor Jacob G, Nadkarni Vinay M
Аннотация
OBJECTIVES: Sepsis is a leading cause of preventable death in low-resource settings, where delays in recognition and emergency department (ED) treatment are common. Limited access to training also contributes to poor outcomes. We hypothesized that a contextualized telesimulation and debriefing program would be associated with better sepsis-related outcomes and time-critical care processes in children presenting to our center in Kumasi, Ghana. We also determined the program's acceptability and feasibility in our clinical providers.
DESIGN: We conducted a 12-month mixed-method quasi-experimental (before vs. after implementation) study at Komfo Anokye Teaching Hospital, 2023-2024. Pediatric ED providers completed 30-minute, low-bandwidth telesimulation sessions using culturally-adapted real patient videos, filmed in the local Ghanaian hospital. Clinical outcomes and care processes were evaluated pre- and post-intervention. Trained observers recorded time-critical interventions: shock recognition, oxygen use, IV access, fluid bolus, reassessment, blood cultures, and antibiotics. Acceptability and feasibility were assessed using validated surveys.
SETTING: Tertiary academic hospital with 1200 beds, including 15 pediatric ED beds and 4 PICU beds.
PARTICIPANTS: ED healthcare providers as well as clinical data from patients 2 months to 14 years old, screened at triage for suspected sepsis or septic shock.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Post- vs pre-implementation care periods had mortality of 7 of 67 (10%) vs. 25 of 70 (36%), which represents an associated decrease in odds ratio (OR) of death 0.2 (95% CI, 0.1-0.5; p = 0.001). The post- vs pre-implementation changes in care characteristics, included: greater odds of supplemental oxygen use (OR 2.4 [95% CI, 1.0-5.7] p = 0.044) and IV placement (OR 3.8 [95% CI, 1.3-13.1] p = 0.012). Also, among trainees, 44/45 agreed that the program was acceptable and feasible.
CONCLUSIONS: In our 2023-2024 pre- vs. post-implementation study, we found that contextualized telesimulation and debriefing were associated with lower odds of mortality, improved characteristics of care, and were acceptable and feasible to the healthcare team.
DESIGN: We conducted a 12-month mixed-method quasi-experimental (before vs. after implementation) study at Komfo Anokye Teaching Hospital, 2023-2024. Pediatric ED providers completed 30-minute, low-bandwidth telesimulation sessions using culturally-adapted real patient videos, filmed in the local Ghanaian hospital. Clinical outcomes and care processes were evaluated pre- and post-intervention. Trained observers recorded time-critical interventions: shock recognition, oxygen use, IV access, fluid bolus, reassessment, blood cultures, and antibiotics. Acceptability and feasibility were assessed using validated surveys.
SETTING: Tertiary academic hospital with 1200 beds, including 15 pediatric ED beds and 4 PICU beds.
PARTICIPANTS: ED healthcare providers as well as clinical data from patients 2 months to 14 years old, screened at triage for suspected sepsis or septic shock.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Post- vs pre-implementation care periods had mortality of 7 of 67 (10%) vs. 25 of 70 (36%), which represents an associated decrease in odds ratio (OR) of death 0.2 (95% CI, 0.1-0.5; p = 0.001). The post- vs pre-implementation changes in care characteristics, included: greater odds of supplemental oxygen use (OR 2.4 [95% CI, 1.0-5.7] p = 0.044) and IV placement (OR 3.8 [95% CI, 1.3-13.1] p = 0.012). Also, among trainees, 44/45 agreed that the program was acceptable and feasible.
CONCLUSIONS: In our 2023-2024 pre- vs. post-implementation study, we found that contextualized telesimulation and debriefing were associated with lower odds of mortality, improved characteristics of care, and were acceptable and feasible to the healthcare team.