The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review

Abstract

Background: Sepsis is a time critical disease and outcomes strongly depend on time to initiation of appropriate treatment in hospital. A range of studies have assessed sepsis recognition in hospital settings, whereas little is known about sepsis recognition in the community. The decision-making of parents in seeking medical care may substantially impact survival of children with sepsis. An improved understanding of the parental perspective in recognizing sepsis is urgently needed to inform the design of education campaigns and consideration of using parental concerns as a trigger in sepsis screening tools. Aim: To review the literature on parental concerns in the diagnosis of sepsis in children. Methods: A literature review on parental concerns in pediatric sepsis was performed accessing publications in PubMed, CINAHL and Medline published between 1990 and 2018. In addition, we compared guidelines and online institutional sepsis recognition tools and assessed whether parental concerns were used for screening. Results: Out of 188 articles reviewed, 11 met the criteria. One article was found prospectively assessing the diagnostic performance of parental concern in children evaluated for infection, indicating high positive (16.4) and negative likelihood ratio (0.23) for sepsis/meningitis in presence of parental concerns. The role of parental concern was listed as a sign assisting recognition of sepsis in four studies reporting original data, and six reviews commented on parental concern listed as a factor upon diagnosis of sepsis. When comparing selected examples of institutional sepsis pathways available online, parental concern was variably listed as a criterion to prompt evaluation for sepsis. Conclusions: Despite some guidelines emphasizing the role of parental concern in recognizing sepsis, there is a paucity of data in the field. An improved understanding of whether parental concerns adds diagnostic value to sepsis recognition at acceptable sensitivity and specificity is urgently needed. Future prospective studies should assess whether including parental concerns in sepsis screening tools benefits the assessment resulting in early diagnosis and treatment of children with sepsis.

“How to Recognize if Your Child Is Seriously Ill” During COVID-19 Lockdown: An Evaluation of Parents' Confidence and Health-Seeking Behaviors

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“…While there is little change from 2016 to 2018, data reinforce the commitment to implementing long-term community-based programs in the St. Louis Metropolitan region that give parents the ability to be active participants in the health care of their children. 7-11…”

“…6 Health systems encourage parents to be active participants in the health care of their children and recognizes the need to assess parents on their ability to identify health needs of their children. [7][8][9][10][11] Parents often express concern for the physical, behavioral, and developmental aspects of their child's health. [12][13][14] Studies of parents' primary health concerns for their child are frequently related to psychosocial issues, such as their child's behavior or even their own parenting.…”

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“…Families of hospitalised preterm/low-birthweight neonates experience stress, insecurity and alienation. 1 2 However, sepsis in the baby-a time-critical, devastating bloodstream infection with an unpredictable clinical courseposes different challenges for a family compared with babies who are not seriously ill. [3][4][5][6] It can range from a localised infection to life-threatening manifestations. 3 4 Complications (eg, septic shock and cardiopulmonary arrest) can progress suddenly and rapidly leading to multiorgan dysfunction and death, despite corrective measures.…”

“…3 This situation can be frightening for parents, with stressors affecting different fronts of their lives. [4][5][6] Families of infected/seriously ill babies are subject to health inequalities, face acute stressors, worry constantly about devastating consequences and continually have feelings of inadequacy. 5 7 8 Moreover, neonates of stressed parents are at the greatest risk of cognitive and behavioural problems compared with healthy neonates.…”