Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Weiss, Scott L.; Fitzgerald, Julie C.; Maffei, Frank A.; Kane, Jason M.; Núñez, Antonio Rodríguez; Hsing, Deyin D.; Franzon, Deborah; Kee, Sze Ying; Bush, Jenny; Roy, Jason; Thomas, Neal J.; Nadkarni, Vinay

doi:10.1186/s13054-015-1055-x

Cited by 98 publications

(81 citation statements)

References 33 publications

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“…Infeksi luka operasi dan jaringan lunak juga dapat menyebabkan sepsis pada anak. [2][3][4] Sebuah studi prevalensi internasional tahun 2015 yang mengumpulkan data dari 26 negara didapatkan prevalensi global sepsis pada unit perawatan intensif anak 8,2%. Rerata usia sepsis adalah 3 tahun dan infeksi terbanyak terdapat pada sistem respirasi (40%).…”

Section: Epidemiologiunclassified

Perkembangan diagnosis sepsis pada anak

Wulandari¹,

Martuti²,

Kaswadi³

2018

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Sepsis merupakan salah satu penyebab utama morbiditas dan mortalitas bayi dan anak di seluruh dunia. Sepsis awalnya didefinisikan sebagai kecurigaan atau infeksi yang terbukti, disertai kondisi klinis SIRS (systemic inflammatory response syndrome), tetapi definisi tersebut kini ditinggalkan. Sesuai konsensus mengenai sepsis terbaru, sepsis didefinisikan sebagai keadaan disfungsi/gagal organ yang mengancam nyawa, disebabkan oleh respon pejamu yang tidak teregulasi terhadap infeksi. Penilaian disfungsi/gagal organ pada anak menggunakan beberapa sistem penilaian, antara lain, Pediatric Multiple Organ Dysfunction Score (P-MODS), Pediatric Logistic Organ Dysfunction (PELOD), Pediatric Logistic Organ Dysfunction–2 (PELOD-2), dan pada konsensus terbaru diperkenalkannya sistem Pediatric Sequential Organ Failure Assessment (pSOFA) yang diadaptasi dari sistem Sequential Organ Failure Assessment (SOFA) dengan hasil validasi menunjukkan bahwa pSOFA memberikan hasil yang sama baik dengan sistem penilaian yang lain. Di Indonesia saat ini, PELOD-2 merupakan sistem penilaian disfungsi organ yang direkomendasikan oleh Ikatan Dokter Anak Indonesia (IDAI) dalam mendiagnosis sepsis pada anak.

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Section: Epidemiologiunclassified

Perkembangan diagnosis sepsis pada anak

Wulandari¹,

Martuti²,

Kaswadi³

2018

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“…The PSCC divided age into six distinct categories in order to take into account age specific vital signs as well as age specific risk factors for invasive infections which in turn affect antibiotic coverage guidelines (9). Pediatric severe sepsis is defined as (1) two or more systemic inflammatory response syndrome criteria (Table 1), (2) confirmed or suspected invasive infection, and (3) cardiovascular dysfunction, acute respiratory distress syndrome, or two or more organ dysfunctions (Table 2) (10). Determination of altered physiology is specific to age dependent vital signs.…”

Section: Defining Sepsismentioning

confidence: 99%

“…Although the PSCC provided a more uniform set of diagnostic criteria, the SPROUT trial found that only 42% of sepsis patients were identified as such by both the clinician and the consensus criteria (3). It is therefore important to realize that retrospective reviews based on ICD-9 codes or administrative data bases do not describe the same patient population as trials utilizing consensus criteria.…”

Section: Defining Sepsismentioning

confidence: 99%

“…It encompasses the top four causes of childhood mortality as reported by the World Health Organization (WHO): severe pneumonia, severe diarrhea, severe malaria, and severe measles (3). In the United States alone, there are 72,000 children hospitalized for sepsis with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion (1, 4, 5).…”

Section: Introductionmentioning

confidence: 99%

“…If patients identified as septic by clinicians are different from research study participants identified as septic, results from those trials may not be applicable to clinical practice. Despite this, the Sepsis PRevalence, OUtcomes, and Therapies (SPROUT) trial recently found that there is only a 42% concordance between physician diagnosis and current diagnostic criteria used for inclusion in research studies (3). Once sepsis can be consistently diagnosed, clinical management tailored to the pediatric patient will need to be refined by large prospective multi-institutional trials.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric sepsis

Mathias

Mira

Larson

2016

Current Opinion in Pediatrics

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Purpose of Review Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72,000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. Recent Findings The definition of pediatric sepsis is currently in a state of evolution and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated. Summary Current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become commonplace.

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International Consensus Criteria for Pediatric Sepsis and Septic Shock

Schlapbach,

Watson,

Sorce

et al. 2024

JAMA

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104

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ImportanceSepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children.ObjectiveTo update and evaluate criteria for sepsis and septic shock in children.Evidence ReviewThe Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria.FindingsBased on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4—respiratory, cardiovascular, coagulation, and/or neurological—organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.Conclusions and RelevanceThe Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.

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Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Cited by 98 publications

References 33 publications

Perkembangan diagnosis sepsis pada anak

Perkembangan diagnosis sepsis pada anak

Pediatric sepsis

International Consensus Criteria for Pediatric Sepsis and Septic Shock

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