Development and prospective validation of pediatric sepsis screening tool in a resource-limited setting

Area of Science:

• Pediatric critical care medicine
• Clinical algorithm development
• Sepsis detection

Background:

• Early recognition of sepsis and septic shock in children is crucial for improving outcomes.
• Existing tools may have limitations in sensitivity, specificity, or resource requirements.
• A pragmatic, bedside algorithm is needed for timely sepsis identification.

Purpose of the Study:

• To develop and prospectively validate a two-stage bedside algorithm for early sepsis recognition.
• To integrate the age-adjusted modified Pediatric Early Warning Score (mPEWS) with the American Academy of Pediatrics (AAP) trigger tool.
• To assess the algorithm's performance against established sepsis definitions and 30-day mortality.

Main Methods:

• Prospective study of children (1 month-18 years) admitted to the hospital (August 2020 - January 2022).
• Stage 1: Alert triggered by age-adjusted mPEWS > 3 plus abnormal temperature or leukocytosis/leukopenia with band form.
• Stage 2: Physician-applied AAP trigger tool; dual positivity defined a positive screen. Performance compared to Sepsis-2, Sepsis-3, Phoenix septic shock definitions, and 30-day mortality.

Main Results:

• The combined mPEWS/AAP tool screened 5.4% of 3202 admissions.
• For septic shock (Phoenix definition), the tool achieved 100% sensitivity and 96.2% specificity (AUC 0.98).
• Screen-positive patients had significantly higher in-hospital (24.2%) and 30-day (13.1%) mortality compared to screen-negative patients (P < 0.001).

Conclusions:

• The mPEWS/AAP trigger tool provides rapid, simple, and clinically based stratification for pediatric sepsis.
• The algorithm demonstrates excellent sensitivity for septic shock and high negative predictive value for sepsis and early mortality.
• Its minimal resource needs make it a practical solution for improving sepsis recognition in resource-constrained settings.