Assessment of clinical outcome of children with sepsis outside the intensive care unit

Abstract

In 2016, in order to identify adult patients with sepsis who are likely to have poor outcomes, the Third International Consensus Definitions Task Force introduced a new bedside index, called the quick Sepsis-related Organ Failure Assessment (qSOFA) score. However, these new criteria have not been validated in the pediatric population. In this study, we sought to assess the qSOFA score for children with sepsis, who are being treated outside the pediatric intensive care units. The qSOFA criteria were revised and applied to a study population of 89 pediatric patients with sepsis, admitted in a pediatric tertiary referral center from 2006 to 2016. The analysis of prognostic performance of qSOFA score for the prediction of severe sepsis showed a sensitivity of 46% (95% CI, 27-67%), a specificity of 74% (95% CI, 62-85%), a positive predictive value of 43% (95% CI, 34-52%), and a negative predictive value of 77% (95% CI, 71-82%). The area under ROC curve for qSOFA score ≥ 2 was 0.602 (95% CI 0.492-0.705).Conclusion: The qSOFA score showed a low accuracy to identify children in the pediatric ward at risk for severe sepsis. Clinical tools are needed to facilitate the diagnosis of impending organ dysfunction in pediatric infection outside of the ICU. What is Known: • One of the major challenges for clinicians is to identify and recognize children with sepsis and impending organ dysfunction, in the emergency and in the pediatric department. • In 2016, members of the Sepsis-3 task force proposed qSOFA, an empirically derived score using simple clinical criteria, to assist clinicians in identifying adult patients with sepsis at risk for poor outcome. What is New: • qSOFA demonstrated insufficient clinical value to be recommended as a screening tool for pediatric sepsis outside ICU. • D-dimer level and blood glucose may be useful biomarkers to identify children at risk for severe sepsis.

Accuracy of a Modified qSOFA Score for Predicting Critical Care Admission in Febrile Children

“…Overall, the LqSOFA demonstrates superior discriminative ability than that reported with the qSOFA in the pediatric population, both in the current study and compared with previous research. 6,9,30 In the current study, the LqSOFA revealed the greatest positive predictive value of all 4 scoring systems, although this was only 34%. The low values for positive predictive value seen across all scoring systems likely reflect the low prevalence of sepsis within the ED population and highlight the difficulty in identifying such cases.…”

SIRS o no SIRS: ¿es esa la infección? Una revisión crítica de los criterios de definición de sepsis

“…Se cuenta con estudios que evaluaron si la disfunción orgánica podría ser también el centro de la definición en sepsis pediátrica (Tabla 2) [57][58][59][60][61][62][63] .…”

Age-adjusted quick Sequential Organ Failure Assessment score for predicting mortality and disease severity in children with infection: a systematic review and meta-analysis

“…Six studies 13,24,25 were designed to evaluate the value of the age-adjusted qSOFA in predicting mortality. Four studies 24,35 evaluated the performance of the age-adjusted qSOFA in predicting disease severity; three studies 24,35 evaluated the value of qSOFA in predicting ICU admission, and one study 35 evaluated the value of qSOFA in predicting the development of severe sepsis 11 . Only one study 23 was designed to evaluate the ability of the ageadjusted qSOFA to predict both ICU transfer and/or mortality within 30 days as the primary outcome.…”

“…Patient sources were as follows: 122,943 ICU patients from four studies 13,25 , 49,448 ED patients from five studies 23,24 , and 178 pediatric tertiary referral center patients from two studies 35 . The majority of the studies were single-center studies (n = 7, 63.6%) 23,24,35 and chose cut-off criteria as ≥ 2 (n = 9, 81.8%) 13,[23][24][25]35 . Most studies (n = 9, 81.8%) 13,[23][24][25]35 adopted the 2005 IPSCC definition for age-specific vital signs criteria.…”

“…The majority of the studies were single-center studies (n = 7, 63.6%) 23,24,35 and chose cut-off criteria as ≥ 2 (n = 9, 81.8%) 13,[23][24][25]35 . Most studies (n = 9, 81.8%) 13,[23][24][25]35 adopted the 2005 IPSCC definition for age-specific vital signs criteria. Six (54.5%) 13,25,35 studies used GCS, four studies (36.4%) 24 used AVPU, and one study 23 used either GCS or AVPU to assess mental status.…”