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Recognition and Management of Sepsis in Children: Practice Patterns in the Emergency Department
Graham C Thompson1, Charles G Macias2
1Department of Pediatrics, Alberta Children's Hospital/University of Calgary, Calgary, Alberta, Canada.
Insights
Pediatric emergency physicians primarily use clinical signs like tachycardia and altered mental status to diagnose sepsis in children. Future research should focus on identifying clinical biomarkers and standardizing care to improve outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care Medicine
- Clinical Practice Research
Background:
- Pediatric sepsis is a significant cause of illness and death in children.
- Understanding current practices and challenges is crucial for advancing research and education in pediatric sepsis.
Purpose of the Study:
- To describe how pediatric emergency physicians recognize and manage sepsis in children.
- To identify key areas for future research and education in pediatric sepsis.
Main Methods:
- A cross-sectional online survey was distributed to pediatric emergency physicians.
- The survey was internally developed, externally validated, and used a modified Dillman methodology.
- Rank scores were calculated to analyze responses.
Main Results:
- Tachycardia, mental-status changes, and abnormal temperature were top clinical indicators for sepsis diagnosis.
- Normal saline was the preferred resuscitation fluid; dopamine was the first-line vasoactive medication.
- Steroid use varied based on presentation complexity, and clinical biomarkers were identified as a research priority.
Conclusions:
- Pediatric emergency physicians rely heavily on clinical metrics for sepsis recognition, despite some practice variability.
- Standardizing care and developing clinical biomarkers are priorities for improving pediatric sepsis management.
- The findings offer a foundation for future research and educational initiatives in pediatric sepsis.
Background:
Pediatric sepsis remains a leading cause of morbidity and mortality. Understanding current practice patterns and challenges is essential to inform future research and education strategies.
Objective:
Our aim was to describe the practice patterns of pediatric emergency physicians (PEPs) in the recognition and management of sepsis in children and to identify perceived priorities for future research and education.
Methods:
We conducted a cross-sectional, internet-based survey of members of the American Academy of Pediatrics, Section on Emergency Medicine and Pediatric Emergency Research Canada. The survey was internally derived, externally validated, and distributed using a modified Dillman methodology. Rank scores (RS) were calculated for responses using Likert-assigned frequency values.
Results:
Tachycardia, mental-status changes, and abnormal temperature (RS = 83.7, 80.6, and 79.6) were the highest ranked clinical measures for diagnosing sepsis; white blood cell count, lactate, and band count (RS = 73.5, 70.9, and 69.1) were the highest ranked laboratory investigations. The resuscitation fluid of choice (85.5%) was normal saline. Dopamine was the first-line vasoactive medication (VAM) for cold (57.1%) and warm (42.2%) shock with epinephrine (18.5%) and norepinephrine (25.1%) as second-line VAMs (cold and warm, respectively). Steroid administration increased with complexity of presentation (all-comers 3.8%, VAM-resistant shock 54.5%, chronic steroid users 72.0%). Local ED-specific clinical pathways, national emergency department (ED)-specific guidelines, and identification of clinical biomarkers were described as future priorities.
Conclusions:
While practice variability exists among clinicians, PEPs continue to rely heavily on clinical metrics for recognizing sepsis. Improved recognition through clinical biomarkers and standardization of care were perceived as priorities. Our results provide a strong framework to guide future research and education strategies in pediatric sepsis.
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