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.

A 12-year-old boy was admitted to our unit for a 3-day history of abdominal and right groin pain, refusal to walk and relapse of fever. His clinical history was uneventful until 2 weeks before, when he developed acute onset of fever, cough and breathlessness. Right upper lobe pneumonia was diagnosed by chest X-ray and intramuscular ceftriaxone treatment was administered for 10 days followed by fever reduction after 3-day therapy. On admission, he appeared quite unwell with fever and wet cough. He was moderately tachycardic and tachypnoeic with oxygen saturations of 94% in air. Chest examination revealed dullness to percussion and reduced breath sound over the upper right lung field with a few crackles. Abdomen was diffusely painful and tender to palpation in the left upper quadrant. Mild splenomegaly was also evident. The proximal portion of the right thigh appeared moderately swollen and warm, with no skin colour changes. Laboratory investigation revealed 23 000/mm 3 white blood cells (77% neutrophils), with normal platelet count and haemoglobin level. Erythrocyte sedimentation rate and C reactive protein were 48 mm/h and 7.4 mg/dL (<0.5), respectively. Liver and renal function tests were normal. Repeated chest X-rays revealed right upper lobe consolidation. FMDB (SENIOR CLINICIAN)We have a previously healthy young boy with persistence of clinical and radiological findings of pneumonia who developed non-respiratory symptoms over the last few days. Correct drug administration, antibiotic resistance, aggravating or underlying conditions, complicated pneumonia and aetiological agents unresponsive to treatment should be taken into account in similar cases. Streptococcus pneumoniae is the most common bacterial cause of community-acquired pneumonia in childhood. Although amoxicillin is recommended as first choice drug for antibiotic therapy, administration of cephalosporins may represent an alternative.1 The patient received correct ceftriaxone dosage, the duration of treatment was adequate, and pneumococcal β-lactam non-susceptibility is rare in Italy. The personal history was not suggestive of either aggravating conditions such as immunodeficiency or underlying lung disease such as cystic fibrosis or immotile cilia dyskinesia. Empyema, necrotising pneumonia and lung abscess represent possible complications of pneumonia, but they can be reasonably excluded by chest X-ray. The role of other aetiological agents such as Mycoplasma pneumoniae and virus should be considered and proper investigation be performed. PO (INFECTIVOLOGIST)Blood cultures were negative. Real-time PCR analysis on blood sample for S pneumoniae and on nasopharyngeal samples for 10 respiratory viruses was also negative. M pneumoniae serology revealed negative immunoglobulin M (IgM) and positive IgG value that was suggestive of past infection. Cold agglutinins were positive (1 : 512) across the thermal range of 4°C -20°C and negative at 37°C. FMDBThese laboratory data do not exclude a recent M pneumoniae infection. Indeed, high titres of cold (IgM)-ag...

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