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Which observed behaviours may reassure physicians that a child is not septic? An international Delphi study
Edward Snelson1,2, Shammi Ramlakhan1,3
1Emergency Department, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
Insights
Expert physicians identified key behaviors like playing and smiling as indicators that an ill child is unlikely to have sepsis. This research aims to improve sepsis diagnosis specificity in pediatric care.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Clinical decision support
Background:
- Current sepsis diagnostic tools often focus on identifying sepsis, with less emphasis on ruling it out.
- Improving the specificity of sepsis diagnosis in children is crucial to avoid unnecessary treatments and healthcare burdens.
- Expert consensus on reassuring clinical features is needed to balance sensitivity and specificity in sepsis diagnostics.
Framework:
- A modified Delphi study involving 195 international clinicians was conducted.
- The study gathered expert opinions on clinical features indicating wellness in unwell children.
- This approach aims to establish a consensus on reassuring signs for sepsis assessment.
Implementation:
- Over 90% of clinicians agreed that age-appropriate verbalization, playing, smiling, and activity are reassuring signs.
- Eating, spontaneous interaction, and normal movement were also identified as reassuring by over 70% of participants.
- Features like consolability and fear of the clinician were not considered adequately reassuring.
Implications:
- The findings provide a framework to guide clinical assessment of unwell children, potentially improving sepsis diagnosis specificity.
- Validated reassuring features can enhance diagnostic aids, leading to more accurate and efficient sepsis identification in pediatric populations.
- This expert-driven consensus can refine clinical practice and diagnostic strategies for pediatric sepsis.
Objective:
In an attempt to improve the diagnosis of sepsis in children, diagnostic aids have concentrated on clinical features that suggest that sepsis is present. Clinicians need to be able to clinically rule out sepsis as well as rule it in. Little is known about which features are consistent with wellness and/or absence of sepsis. Guidelines are therefore likely to improve sensitivity without preserving specificity. We aimed to gather expert opinion on which (if any) features would make clinicians consider a child to be unlikely to have sepsis.
Design:
We undertook a modified two-round international Delphi study, where clinicians were asked for features they believed were indicators of wellness in an ill child.
Participants:
One hundred and ninety-five clinicians (predominantly physicians) who routinely assessed unwell children and had been doing so for most of their careers.
Results:
Over 90% of respondents rated age-appropriate verbalisation, playing, smiling and activity as reassuring that a child was unlikely to have sepsis. Eating, spontaneous interaction and normal movement were also agreed to be reassuring by over 70% of participants. Consolability and showing fear of the clinician were not felt to be adequately reassuring. There was wide range of opinion on how reassuring the use of an electronic device was thought to be.
Conclusions:
This study confirms that physicians are reassured by specific behaviours in ill children, and provides a framework which may be used to help guide the assessment of the unwell child. Validation of individual features could lead to improved specificity of diagnostic aids for diagnosing sepsis.
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