Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia
Objective The Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.Design Prospective multicentre study conducted between August 2018 and December 2019. We...
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BMJ Publishing Group
2023-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/1/e061431.full |
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| author | Paula Lister Kristen Gibbons Luregn J Schlapbach Adam Irwin Michael Rice Sainath Raman Amanda Harley Patricia Gilholm |
| author_facet | Paula Lister Kristen Gibbons Luregn J Schlapbach Adam Irwin Michael Rice Sainath Raman Amanda Harley Patricia Gilholm |
| author_sort | Paula Lister |
| collection | DOAJ |
| description | Objective The Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.Design Prospective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds.Setting Twelve emergency departments (EDs) in Queensland, Australia.Participants 3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis.Interventions A 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination.Primary outcome measure Senior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED.Results The 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results.Conclusions A simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis. |
| format | Article |
| id | doaj-art-54517b28f8a74263888fb367854c1b82 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-54517b28f8a74263888fb367854c1b822025-02-07T16:05:09ZengBMJ Publishing GroupBMJ Open2044-60552023-01-0113110.1136/bmjopen-2022-061431Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, AustraliaPaula Lister0Kristen Gibbons1Luregn J Schlapbach2Adam Irwin3Michael Rice4Sainath Raman5Amanda Harley6Patricia Gilholm7Paediatric Critical Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, AustraliaChild Health Research Centre, The University of Queensland, Brisbane, Queensland, AustraliaDepartment of Intensive Care and Neonatology and Children`s Research Center, University Children`s Hospital Zürich, Zurich, SwitzerlandQueensland Children`s Hospital, South Brisbane, Queensland, AustraliaClinical Excellence Queensland, Queensland Health, Brisbane, Queensland, AustraliaQueensland Children`s Hospital, South Brisbane, Queensland, AustraliaSchool of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, AustraliaChild Health Research Centre, The University of Queensland, South Brisbane, Queensland, AustraliaObjective The Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.Design Prospective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds.Setting Twelve emergency departments (EDs) in Queensland, Australia.Participants 3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis.Interventions A 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination.Primary outcome measure Senior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED.Results The 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results.Conclusions A simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis.https://bmjopen.bmj.com/content/13/1/e061431.full |
| spellingShingle | Paula Lister Kristen Gibbons Luregn J Schlapbach Adam Irwin Michael Rice Sainath Raman Amanda Harley Patricia Gilholm Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia BMJ Open |
| title | Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia |
| title_full | Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia |
| title_fullStr | Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia |
| title_full_unstemmed | Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia |
| title_short | Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia |
| title_sort | validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department a statewide prospective cohort study in queensland australia |
| url | https://bmjopen.bmj.com/content/13/1/e061431.full |
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