Related Experiment Video
Updated: May 9, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Development, Implementation, and Evaluation of an Early Sepsis Screening Tool at Triage in a Pediatric Emergency
Natalia Lopera Múnera1, Maria E Chávez1, Lourdes Samaniego1
1Hospital General Pediátrico Niños de Acosta Ñu, San Lorenzo, Paraguay.
Insights
A new sepsis screening tool for pediatric emergency departments (PEDs) effectively identifies sepsis in febrile or hypothermic children. Key predictors include circulatory alteration, poor capillary refill, and critical risk factors, improving early detection and treatment.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Diagnostics
Background:
- Sepsis screening tools are crucial for timely intervention in Pediatric Emergency Departments (PEDs).
- Developing and validating effective screening tools is essential for improving patient outcomes.
Purpose of the Study:
- To develop, implement, and evaluate a novel sepsis screening tool for pediatric patients presenting with fever or hypothermia in a PED.
- To assess the tool's diagnostic accuracy and identify key predictors of sepsis.
Main Methods:
- A 3-phase study (design, implementation, evaluation) conducted over 13 months.
- The tool integrated Pediatric Assessment Triangle (PAT), parental concern, vital signs, and risk factors.
- Prospective diagnostic test evaluation using intention-to-treat, Phoenix criteria, and final diagnosis as reference standards.
Main Results:
- The tool screened 16,771 of 40,005 febrile/hypothermic PED patients, with a 1.4% positive rate.
- Patients with positive screens had significantly higher rates of critical triage levels, hospitalization, PICU admission, and mortality.
- High sensitivity (0.80) and specificity (0.99) for sepsis detection; key predictors included circulatory alteration (OR: 2.8), abnormal capillary refill (OR: 1.9), and critical risk factors (OR: 2.1).
Conclusions:
- The developed sepsis screening tool demonstrated strong performance in identifying sepsis in a pediatric emergency setting.
- Circulatory alteration on PAT, abnormal capillary refill, and critical risk factors are significant predictors of sepsis in this population.
Objective:
Sepsis screening tools in Pediatric Emergency Departments (PEDs) enable timely alerts and treatment. This study aimed to develop, implement, and evaluate a sepsis screening tool applied during triage in patients with fever or hypothermia in a PED.
Methods:
The study was conducted in 3 phases (design, implementation, and evaluation) from July 1, 2023, to July 31, 2024. The screening tool included the Pediatric Assessment Triangle (PAT), parental concern, critical appearance, vital signs, mental status, skin condition, capillary refill, and risk factors, with results classified as positive or negative. Evaluation followed an observational, prospective diagnostic test design using 3 reference standards: intention-to-treat standard, Phoenix criteria, and final diagnosis at case closure. Patients aged >28 days to <18 years with fever or hypothermia were included. Results were analyzed for diagnostic accuracy (sensitivity, specificity, predictive values, and likelihood ratios). Additional analyses were performed to examine the triggers of positive alerts and causes of missed alerts.
Results:
During the evaluation period, 16,771 of 40,005 PED patients had fever or hypothermia. The tool was positive in 1.4% (240/16,672). These patients had significantly more triage levels I and II (99.6% vs. 4.8%), higher hospitalization rates (66% vs. 5%), pediatric intensive care unit admissions (11% vs. 0.03%), and mortality (3.8% vs. 0.01%). For sepsis at case closure, the tool showed sensitivity of 0.80, specificity of 0.99, positive predictive value of 0.33, negative predictive value of 1, positive likelihood ratio of 84, and negative likelihood ratio of 0.20. Circulatory alteration in the PAT [odds ratio (OR): 2.8], abnormal capillary refill (OR: 1.9), and critical risk factors (OR: 2.1) independently increased the risk of sepsis.
Conclusions:
The sepsis screening tool evaluated demonstrated good performance in detecting sepsis in the PED. Circulatory alteration in the PAT, abnormal capillary refill, and presence of a critical risk factor were key sepsis predictors.
