Understanding the Urgency of Pediatric Sepsis

By: Sarma Velamuri, M.D., Mihir Pethe

Dec 7th 2020

Although the World Health Organization (WHO) does not track sepsis specifically, sepsis encompasses the top four causes of childhood mortality as tracked by the WHO: severe pneumonia, severe diarrhea, severe malaria, and severe measles. By this assessment, sepsis is undoubtedly the leading cause of childhood death worldwide, resulting in 7.5 million deaths annually.

Despite its impact, pediatric sepsis is not a major focus in the non-acute-care pediatric clinic or the laboratory, as researchers, clinicians, and administrators alike all may view childhood mortality through the lens of the underlying disease or infection, rather than through the lens of sepsis. Sepsis is different from infections even though providers sometimes use the term interchangeably.

To properly treat pediatric sepsis, hospitals need to understand what it looks like so that clinicians can identify it earlier. Pediatric sepsis presents differently than adult sepsis. For example, blood pressure does not begin to drop until their sepsis has become quite severe, while a moderate drop in blood pressure is a valuable screening metric for adults. This is because compensatory mechanisms in children, what we sometimes think of as “reserve capacity”, is higher than that in adults so the child does fine until they are not.

Often the clinician unfamiliar with sepsis may be looking for a dip in blood pressure to begin sepsis protocols. The situation of children experiencing sepsis can deteriorate rapidly while the hospital staff remains unaware of the underlying issue. Also, sepsis has historically been looked at in a reactionary way and needs to instead be looked at predictively.

Because of this problem of visibility and getting timely treatment to patients, multiple systemic reviews have recommended implementing screening processes. The Surviving Sepsis Campaign’s International Guidelines for handling pediatric sepsis recommended adding a screening process, with the caveat that screening tools are best when dynamic in what they can be configured to screen for. This allows for different definitions and different hospitals to screen based on more specific and context dependent criteria, rather than rigid screening criteria that can cause false alarms and alarm fatigue. Luminare’s Sagitta platform was built with this flexibility in mind; hospitals can choose when and how the system alerts them and configure it in a way that best suits their workflow, meaning that alarms and red flags are dealt with the appropriate level of urgency.

Along with better screening, the guidelines strongly support having a specific sepsis protocol that a hospital can follow when a patient is identified as potentially septic. Sagitta is primarily a workflow management tool, not just a screening tool, meaning that it can integrate and facilitate any type of sepsis protocol that a hospital may develop.

Understanding and combating pediatric sepsis needs to be a core focus in hospitals, rather than a quality improvement sidenote. By focusing attention on pediatric sepsis, hospitals force themselves to build higher quality systems that can identify patients who may fall through the cracks. Simple organizational steps can be taken to significantly improve outcomes and reduce child mortality in hospitals, and Sagitta can help hospitals make those changes.

TL;DR version

Outline:

• Pediatric sepsis is a major and underreported issue around the world
  • WHO numbers about deaths, combined from other major childhood killers
• To properly treat it, we must understand what it looks like
  • Different screening criteria
    • Review board identified screening as a weak recommendation precisely because there must be some amount of tailoring to the screening system
    • Blood pressure presents differently
• To treat it, we must have protocol
  • From review board recommendations
  • Workflow management tool can make protocol easier to implement
• Conclusion
  • Understanding pediatric sepsis needs to be considered as a major topic, not just a side screening process
  • Simple steps can be taken to reduce the severity and prevalence of pediatric sepsis

Sources Used:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913352/
https://journals.lww.com/ccejournal/fulltext/2020/06000/pediatric_sepsis_definition_a_systematic_review.11.aspx
https://www.yalemedicine.org/conditions/sepsis-in-kids/
https://journals.lww.com/pccmjournal/Fulltext/2020/02000/Surviving_Sepsis_Campaign_International_Guidelines.20.aspx
https://pediatrics.aappublications.org/content/144/6/e20191790