The objective of this study was to describe the clinical spectrum of patients presenting with shock
or developing shock
in a pediatric emergency department (ED) during an 8-year period.
An observational study of all pediatric ED patients with shock
between September 1998 and September 2006 was performed. Trauma activations were excluded. A structured, explicit chart review using a standardized abstraction form and case definition was completed by 3 physicians board certified in pediatric emergency medicine. Interrater reliability was monitored.
A total of 147 cases of shock
were identified. Septic shock
was the underlying physiology in 57% of cases. A pathogen was identified in 45% of these cases. Hypovolemic shock
due to gastroenteritis, metabolic disease, surgical emergencies, or hemorrhage was the cause
in 24% of cases. Distributive shock
represented 14% of cases. Cardiogenic shock
contributed to 5% of cases. Patients with septic shock
received a mean of 58 mL/kg of crystalloid or colloid versus 50 mL/kg in patients with other causes. Intubation and vasopressor use was required in 41% and 21% of cases, respectively. Clinical signs of shock
developed in the ED after initially presenting without clinical signs of shock
in 14% of study subjects. Nearly half of these episodes occurred after the administration of antimicrobials or performance of a lumbar puncture. Mortality was 6% overall and 5% in septic shock
Pediatric ED patients with shock
represent a diverse population with substantial mortality. Of 147 patients, 21 presented without clinical signs of shock
and deteriorated to a clinical condition meeting the definition of shock
during the ED course.