The influential Surviving Sepsis Campaign recently released guidelines on how hospitals can diagnose and treat sepsis in children.
The recommendations are the first from the Surviving Sepsis Campaign that address the condition in children. Clinicians have mostly focused on identifying and treating sepsis in adults because it's more prevalent and dangerous for those patients. But there's a growing recognition that children are also at risk, said Dr. Scott Weiss, an intensivist at Children's Hospital of Philadelphia and co-vice-chair of the pediatric guidelines.
Improvements in pediatric medical treatment mean more infants and children with complex medical conditions survive, but they also have weakened immune systems that make them vulnerable to infections that can lead to sepsis. As a result, "we are seeing a greater number of children who are at risk for sepsis," Weiss said.
About 72,000 children are hospitalized each year in the U.S. with sepsis and the mortality rate is about 25%. By comparison, 1 in 3 adults who die in the hospital setting have sepsis.
The Surviving Sepsis Campaign is influential, with the CMS closely aligning their measures on hospital compliance with sepsis management to the campaign's guidelines.
The new pediatric guidelines offer recommendations about how hospitals can identify pediatric patients with sepsis as well as treat it.
The campaign recommends clinicians assess children's blood flow beyond checking their blood pressure to determine if a child is septic or at risk, such as checking pulse strength and the temperature of their hands and feet. Children with the typical warning signs of sepsis in adults—fast heart rate or breathing—may not have the condition at all, and the child may just be nervous or anxious.
"It's often difficult to distinguish a child with early sepsis from a child with an uncomplicated infection," Weiss said.
The campaign was unable to recommend a specific algorithm hospitals can implement in their electronic health record systems to detect pediatric patients at risk of sepsis because there hasn't been enough research on the topic. It's a relatively common practice in hospitals for EHRs to alert clinicians to patients at risk for sepsis by monitoring their vital signs. Even so, the campaign still recommended hospitals implement screening tools specific for sepsis in children.
"We provide several examples of screening algorithms that pediatric institutions have successfully implemented," Weiss said.
The guidelines for treating sepsis in children are similar to those for adults with some exceptions. For instance, the campaign recommends blood cultures be collected before antibiotics are administered if the patient doesn't demonstrate clear signs of septic shock but has sepsis-associated organ dysfunction, which is also recommended for adults. The difference is the time frame hospitals should wait before administering antibiotics. For adults, the campaign recommends collecting blood cultures within an hour before administering antibiotics. For children, the recommendation is to administer antibiotics within three hours of the initial suspicion of sepsis or sooner and immediately if shock develops.
There is research evidence that mortality rates weren't different for children who received antibiotics in under an hour and those who received antibiotics within three hours, according to the guidelines.
The Surviving Sepsis Campaign also emphasized the importance of closely monitoring the appropriateness of continued antibiotic use given concerns around antibiotic resistance.
The guidelines don't consider hospitals' resource availability, according to Weiss. The campaign plans to release additional tips later this year on how to implement the guidelines with limited resources.
The guidelines were created with feedback from 49 international experts and published in two academic journals.
