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Published on: April 7, 2023
Designing a pediatric severe sepsis screening tool
Robert J Sepanski1, Sandip A Godambe2, Christopher D Mangum1
1Department of Performance Improvement, Children's Hospital of The King's Daughters , Norfolk, VA , USA.
Insights
A new screening tool significantly improves the prediction of pediatric severe sepsis (SS) and septic shock in emergency departments. This tool offers a threefold increase in positive predictive value compared to previous methods.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Critical Care Medicine
Background:
- Pediatric severe sepsis (SS) and septic shock require early detection for improved outcomes.
- Existing screening tools often lack sufficient predictive accuracy for widespread clinical use.
- Integration into electronic medical records (EMR) is crucial for active, real-time patient screening.
Purpose of the Study:
- To develop and validate an enhanced screening tool for pediatric severe sepsis and septic shock.
- To improve the predictive value of sepsis detection in pediatric emergency departments.
- To create a tool suitable for integration into electronic medical records for active screening.
Main Methods:
- Identified "gold standard" SS cases through diagnosis codes and chart review of 7,402 children.
- Refined International Consensus Conference on Pediatric Sepsis (ICCPS) parameters using receiver operating characteristic (ROC) analysis.
- Derived age-specific heart rate (HR) and respiratory rate (RR) values from 143,603 children.
- Validated the final tool using a split-sample approach.
Main Results:
- The optimized tool achieved a positive predictive value of 48.7%, a nearly threefold improvement over the ICCPS tool.
- Incorporated age-specific HR/RR thresholds and linear temperature correction.
- Significantly reduced false positive systemic inflammatory response syndrome identifications (nearly sixfold lower).
Conclusions:
- The developed screening tool demonstrates substantially improved predictive value for pediatric severe sepsis and septic shock.
- The tool's design facilitates integration into EMR systems for active screening in pediatric EDs.
- This advancement offers a more accurate and efficient method for early sepsis detection in children.
Abstract:
We sought to create a screening tool with improved predictive value for pediatric severe sepsis (SS) and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric emergency department (ED). "Gold standard" SS cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over 2 months. The tool's identification of SS was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS) parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool's predictive value based on receiver operating characteristics (ROC). Age-specific normal and abnormal values for heart rate (HR) and respiratory rate (RR) were empirically derived from 143,603 children seen in a second pediatric ED over 3 years. Univariate analyses were performed for each measure in the tool to assess its association with SS and to characterize it as an "early" or "late" indicator of SS. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool's positive predictive value was 48.7%, a significant, nearly threefold improvement over the original ICCPS tool. False positive systemic inflammatory response syndrome identifications were nearly sixfold lower.
