Comparison of sepsis definitions in a resource poor environment

Sepsis is an important cause of childhood death in developing countries. The International Pediatric Sepsis Consensus Conference (IPSCC) guidelines for definition has five categories and requires complex information, which may be difficult to access in resource poor settings, possibly leading to under-diagnosis and problems with triage, referral and documentation for public health assessments. We aimed to provide a workable system for grading sepsis categories, assess this against the IPSCC definition and use this information to guide further adaptations. We conducted a prospective observational study of consecutive admissions to a pediatric intensive care unit of a public hospital between August and September 2006. We recorded history and demographic, clinical, investigative, treatment and outcome details. We compared the performance of the IPSCC scoring system to the modified system. We studied one hundred consecutive admissions and collected data for the modified format. The distribution of sepsis cases and (deaths) was as follows: systemic inflammatory response syndrome 26 (2), sepsis 30 (5), severe sepsis/septic shock 15 (11), organ dysfunction 2 (2) and no sepsis 27 (3). Overall mortality was 23%. Despite its simplicity, the modified system corresponded well to the IPSCC system except for the systemic inflammatory response syndrome category. We suggest adaptations to improve agreement with IPSCC whilst maintaining ease of use. It is possible to simplify the IPSCC score to provide information in a resource poor setting but only further studies will be able to assess robustness in the field.