Association between hypotension and serious illness in the emergency department: an observational study

Hagedoorn, Nienke N.; Zachariasse, Joany M; Moll, Henriëtte A.

doi:10.1136/archdischild-2018-316231

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…5 7 8 10-14 32 33 In our previous single-centre study, we found an association of high Shock Index for hospital and ICU admission in children with different presentations at the ED. 14 Although this previous study included both febrile and non-febrile children, our study confirms an association of high Shock Index with SBI, ILSI and ICU admission in febrile children.…”

Section: Discussionsupporting

confidence: 77%

“…6 In paediatrics, evidence of the Shock Index is limited to children with trauma, [7][8][9][10] children with septic shock [11][12][13] and a single-centre general ED population. 14 To our knowledge, the Shock Index as a potential non-invasive measure in the early assessment for recognition of serious illness, including need for immediate life-saving interventions (ILSIs) and SBI, has not yet been evaluated. In addition, the association of the Shock Index with ICU admission in febrile children in a multicentre cohort is still unknown.…”

Section: Introductionmentioning

confidence: 99%

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Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

et al. 2021

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Objective(1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children.Design/settingObservational study in 11 European EDs (2017–2018).PatientsFebrile children with measured blood pressure.Main outcome measuresSerious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs).ResultsOf 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8.ConclusionsHigh Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

et al. 2021

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“…In our cohort, BP was by far the most commonly missed parameter, and similarly low rates of BP measurement in the paediatric ED have been reported consistently in the previous research. [38][39][40] This affects the development of scoring systems that include BP, as they are using cohorts with significant amounts of missing data. Furthermore, the 'real-world' performance of a score may be greatly affected if one parameter is consistently not measured, reducing opportunities for the reliable detection of serious illness.…”

Section: Discussionmentioning

confidence: 99%

Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study

et al. 2021

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ObjectivePaediatric Early Warning Scores (PEWS) are widely used in the UK, but the heterogeneity across tools and the limited data on their predictive performance represent obstacles to improving best practice. The standardisation of practice through the proposed National PEWS will rely on robust validation. Therefore, we compared the performance of the National PEWS with six other PEWS currently used in NHS hospitals, for their ability to predict critical care (CC) admission in febrile children attending the emergency department (ED).DesignRetrospective single-centre cohort study.SettingTertiary hospital paediatric ED.ParticipantsA total of 11 449 eligible febrile ED attendances were identified from the electronic patient record over a 2-year period. Seven PEWS scores were calculated (Alder Hey, Bedside, Bristol, National, Newcastle and Scotland PEWS, and the Paediatric Observation Priority Score, using the worst observations recorded during their ED stay.OutcomesThe primary outcome was CC admission within 48 hours, the secondary outcomes were hospital length of stay (LOS) >48 hours and sepsis-related mortality.ResultsOf 11 449 febrile children, 134 (1.2%) were admitted to CC within 48 hours of ED presentation, 606 (5.3%) had a hospital LOS >48 hours. 10 (0.09%) children died, 5 (0.04%) were sepsis-related. All seven PEWS demonstrated excellent discrimination for CC admission (range area under the receiver operating characteristic curves (AUC) 0.91–0.95) and sepsis-related mortality (range AUC 0.95–0.99), most demonstrated moderate discrimination for hospital LOS (range AUC 0.69–0.75). In CC admission threshold analyses, bedside PEWS (AUC 0.90; 95% CI 0.86 to 0.93) and National PEWS (AUC 0.90; 0.87–0.93) were the most discriminative, both at a threshold of ≥6.ConclusionsOur results support the use of the proposed National PEWS in the paediatric ED for the recognition of suspected sepsis to improve outcomes, but further validation is required in other settings and presentations.

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“…Another limitation is that blood pressure, cyanosis and diminished urine output were not included in the data collection. A previous study showed that, although hypotension is associated with serious illness in children, its sensitivity is limited as routine measurement in all children attending the ED42 43 and it is a late sign in children with sepsis in comparison with adults. On the other hand, in adolescents, similar to adults, hypotension might present earlier in the disease course and thus including blood pressure could provide valuable information.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study

et al. 2022

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ObjectiveMost studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although population studies have described an increased risk of sepsis in adolescents, little is known about febrile adolescents attending the emergency department (ED). We aimed to describe patient characteristics and management of febrile adolescents attending the ED.Design and settingThe MOFICHE/PERFORM study (Management and Outcome of Febrile Children in Europe/Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union), a prospective multicentre study, took place at 12 European EDs. Descriptive and multivariable regression analyses were performed, comparing febrile adolescents (12–18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection).Results37 420 encounters were included, of which 2577 (6.9%) were adolescents. Adolescents were more often triaged as highly urgent (38.9% vs 34.5%) and described as ill appearing (23.1% vs 15.6%) than younger children. Increased work of breathing and a non-blanching rash were present less often in adolescents, while neurological signs were present more often (1% vs 0%). C reactive protein tests were performed more frequently in adolescents and were more often abnormal (adjusted OR (aOR) 1.7, 95% CI 1.5 to 1.9). Adolescents were more often diagnosed with SBI (OR 1.8, 95% CI 1.6 to 2.0) and sepsis/meningitis (OR 2.3, 95% CI 1.1 to 5.0) and were more frequently admitted (aOR 1.3, 95% CI 1.2 to 1.4) and treated with intravenous antibiotics (aOR 1.7, 95% CI 1.5 to 2.0).ConclusionsAlthough younger children presented to the ED more frequently, adolescents were more often diagnosed with SBI and sepsis/meningitis. Our data emphasise the importance of awareness of severe infections in adolescents.

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Association between hypotension and serious illness in the emergency department: an observational study

Cited by 12 publications

References 35 publications

Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study

Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study

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