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

This study aimed to develop and prospectively validate a pragmatic two-stage bedside algorithm, integrating an age-adjusted modified Pediatric Early Warning Score (mPEWS) with the American Academy of Pediatrics (AAP) trigger tool for early recognition of sepsis and septic shock.

This prospective study enrolled children admitted to a hospital from August 2020 to January 2022; all admissions aged 1 month-18 years were monitored. Stage-1 alerted when age-adjusted mPEWS is more than 3, plus abnormal temperature or leukocytosis/leukopenia with band form. Stage-2 applied the trigger tool by physicians; dual positivity in both stages defined a positive screening test. Diagnostic test performance was compared and calculated with Sepsis-2 (sepsis), Sepsis-3 (septic shock), Phoenix septic shock definitions, and 30-day mortality.

Among 3202 admissions (1765 patients; median age: 81 months; 54% male), 172 episodes (5.4%) met both stages of the new screening. Compared to the Sepsis-2 criteria, the tool achieved 60.4% sensitivity, 99.1% specificity, 84.3% positive predictive value (PPV), 96.9% negative predictive value (NPV), and area under the curve (AUC) of 0.80. For the Phoenix septic shock definition, sensitivity increased to 100% with 96.2% specificity, 30.2% PPV, 100% NPV, and AUC 0.98. Predicting 30-day mortality yielded 65.0% sensitivity, 95.1% specificity, 13.1% PPV, 99.6% NPV, and AUC 0.80. Screen-positive patients experienced markedly higher in-hospital (24.2% vs. 0.9%) and 30-day (13.1% vs. 0.4%) mortality than those screening negative (P < 0.001).

The combined mPEWS/APP trigger tool delivers rapid, simple with entirely clinical stratification, and excellent sensitivity for septic shock with high NPV for sepsis and early mortality. Its simplicity and minimal resource requirements make it a practical solution for improving timely sepsis recognition in resource-constrained pediatric settings.