Balamuth et al developed a protocol for recognition of pediatric sepsis in the Emergency Department. This can help to identify a pediatric patient who may benefit from more aggressive management. The authos are from the University of Pennsylvania, Children's Hospital of Philadelphia, Northwestern University and Children's Hospital of Chicago.
Patient selection: pediatric patient in the Emergency Department
Parameters:
(1) heart rate for age
(2) blood pressure for age
(3) body temperature
(4) clinical concern about infection
(5) high-risk condition
(6) capillary refill time
(7) mental status exam
High risk conditions:
(1) asplenia
(2) transplant (bone marrow, solid organ)
(3) indwelling central venous catheter (CVC)
(4) malignancy
(5) significant central nervous system abnormality
(6) technology dependence
(7) immunodeficiency or immunosuppression
(8) < 56 days off age
Findings that may be indicative of sepsis:
(1) tachycardia
(2) hypotension
(3) fever or hypothermia
(4) clinical concern about infection
(5) one or more high risk conditions
(6) poor capillary refill
(7) abnormal mental status exam
A patient with multiple findings should be evaluated for the possibility of sepsis.
An additional step might be to look for anything that might be masking the signs of serious infection (antipyretics, etc).
