BACKGROUND AND OBJECTIVES:
Definitions for pediatric sepsis were established in 2005 without data-driven criteria. It is unknown whether the more recent adult Sepsis-3 definitions meet the needs of providers caring for children. We aimed to explore the use and applicability of criteria to diagnose sepsis and septic shock in children across the world.
METHODS:
This is an international electronic survey of clinicians distributed across international and national societies representing pediatric intensive care, emergency medicine, pediatrics, and pediatric infectious diseases. Respondents stated their preferences on a 5-point Likert scale.
RESULTS:
There were 2835 survey responses analyzed, of which 48% originated from upper-middle income countries, followed by high income countries (38%) and low or lower-middle income countries (14%). Abnormal vital signs, laboratory evidence of inflammation, and microbiologic diagnoses were the criteria most used for the diagnosis of “sepsis.” The 2005 consensus definitions were perceived to be the most useful for sepsis recognition, while Sepsis-3 definitions were stated as more useful for benchmarking, disease classification, enrollment into trials, and prognostication. The World Health Organization definitions were perceived as least useful across all domains. Seventy one percent of respondents agreed that the term sepsis should be restricted to children with infection-associated organ dysfunction.
CONCLUSIONS:
Clinicians around the world apply a myriad of signs, symptoms, laboratory studies, and treatment factors when diagnosing sepsis. The concept of sepsis as infection with associated organ dysfunction is broadly supported. Currently available sepsis definitions fall short of the perceived needs. Future diagnostic algorithms should be pragmatic and sensitive to the clinical settings.
Dominance in the peer group is important for adolescents. Resource Control Theory posits that both coercive and prosocial (positively assertive) strategies are associated with dominance. Combining Resource Control Theory with Socioanalytic Theory on personality, we hypothesized that inspiring group members would be an additional effective strategy. This study examined whether the three behavioral strategies and two types of social skills (social competence and manipulation) predicted dominance (resource control and popularity). Participants were 619 Dutch adolescents (Mage = 13.1; 47% female) in the first grade of secondary school. They completed peer reports (behavioral strategies and dominance) and self-reports (social skills). Only inspirational and coercive strategies substantially predicted dominance. Main effects of social skills emerged. Moderation between strategies and social skills was only observed for girls (e.g., coercive strategy use was associated with more popularity for girls with higher levels of social manipulation skills). This study furthered our understanding of the predictors of dominance in adolescence by including inspirational behavior and examining prosocial and antisocial skills.
Developmental surveillance tools are used to closely monitor the early development of infants and young children. This study provides a novel implementation of a multidimensional item response model, using Bayesian hierarchical priors, to construct developmental profiles for a small sample of children ( N = 115) with sparse data collected through an online developmental surveillance tool. The surveillance tool records 348 developmental milestones measured from birth to three years of age, within six functional domains: auditory, hands, movement, speech, tactile, and vision. The profiles were constructed in three steps: (1) the multidimensional item response model, embedded in the Bayesian hierarchical framework, was implemented in order to measure both the latent abilities of the children and attributes of the milestones, while retaining the correlation structure among the latent developmental domains; (2) subsequent hierarchical clustering of the multidimensional ability estimates enabled identification of subgroups of children; and (3) information from the posterior distributions of the item response model parameters and the results of the clustering were used to construct a personalized profile of development for each child. These individual profiles support early identification of, and personalized early interventions for, children with developmental delay.
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