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Emergency Department Sepsis Triage Scoring Tool Elements Associated With Hypotension Within 24 Hours in Children With
Alexandra H Baker, Vanessa M Mazandi, Jackson S Norton1
1Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.
Insights
In children with fever and tachycardia in the emergency department, prolonged capillary refill and severe cerebral palsy predict progression to septic shock. These findings aid in early identification of pediatric sepsis progression.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Critical Care
Background:
- Pediatric sepsis screening tools are standard in emergency departments (EDs) for recognizing severe sepsis.
- The predictive value of these screening tools for disease progression remains unclear.
Purpose of the Study:
- To determine if elements of a sepsis triage trigger tool predict progression to hypotensive shock in children with fever and tachycardia in the ED.
- To identify specific vital signs or clinical signs associated with sepsis progression.
Main Methods:
- Retrospective case-control study of children (≤18 years) presenting to the ED with fever and tachycardia.
- Cases developed hypotensive shock within 24 hours; controls did not.
- Primary outcome: proportion of encounters with abnormal vital/clinical signs from sepsis triage score.
Main Results:
- 94 cases and 186 controls were analyzed.
- Severe cerebral palsy (aOR 9.4) and abnormal capillary refill (aOR 3.1) at triage were significantly associated with progression to hypotensive shock.
- These associations remained significant in the adjusted multivariable model.
Conclusions:
- Prolonged capillary refill and severe cerebral palsy are predictive of progression to decompensated septic shock in pediatric ED patients with fever and tachycardia.
- These findings highlight key indicators for monitoring high-risk children despite standard ED care.
Objective:
Pediatric sepsis screening is becoming the standard of care for children presenting to the emergency department (ED) and has been shown to improve recognition of severe sepsis, but it is unknown if these screening tools can predict progression of disease. The objective of this study was to determine if any elements of a sepsis triage trigger tool were predictive of progression to hypotensive shock in children presenting to the ED with fever and tachycardia.
Methods:
This study is a retrospective case-control study of children ≤18 years presenting to an ED with fever and tachycardia, comparing those who went on to develop hypotensive shock in the subsequent 24 hours (case) to those who did not (control). Primary outcome was the proportion of encounters where the patient had specific abnormal vital signs or clinical signs as components of the sepsis triage score. The secondary outcomes were the proportion of encounters where the patient had a sepsis risk factor.
Results:
During the study period, there were 94 patients who met case criteria and 186 controls selected. In the adjusted multivariable model, the 2 components of the sepsis triage score that were more common in case patients were the presence of severe cerebral palsy (adjusted odds ratio, 9.4 [3.7, 23.9]) and abnormal capillary refill at triage (adjusted odds ratio, 3.1 [1.4, 6.9]).
Conclusions:
Among children who present to a pediatric ED with fever and tachycardia, those with prolonged capillary refill at triage or severe cerebral palsy were more likely to progress to decompensated septic shock, despite routine ED care.
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