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Assessment of clinical outcome of children with sepsis outside the intensive care unit

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Abstract

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.

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Abbreviations

BP:

Blood pressure

ICU:

Intensive care units

IQR:

Interquartile range

NPV:

Negative predictive values

PPV:

Positive predictive values

PICU:

Pediatric intensive care units

qSOFA:

Quick Sepsis-related Organ Failure Assessment

PSCC:

Pediatric Sepsis Consensus Congress

ROC:

Receiver operating characteristic

SD:

Standard deviation

SE:

Sensibility

SIRS:

Systemic inflammatory response syndrome

SOFA:

Sequential [Sepsis-related] Organ Failure Assessment

SP:

Specificity

SS:

Severe sepsis

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Author information

Authors and Affiliations

  1. Pediatrics and Infectious Disease Unit, G. Salesi Children’s Hospital, Ancona, Italy

    Federica Zallocco, Patrizia Osimani, Ines Carloni, Vittorio Romagnoli, Silvia Angeloni & Salvatore Cazzato

  2. Pediatrics and Infectious Disease Unit, Department of Mother and Child Health, G. Salesi Children’s Hospital, Via Corridoni 11, 60123, Ancona, Italy

    Salvatore Cazzato

Authors
  1. Federica Zallocco
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  2. Patrizia Osimani
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  3. Ines Carloni
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  4. Vittorio Romagnoli
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  5. Silvia Angeloni
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  6. Salvatore Cazzato
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Contributions

All authors had full access to all of the data for this study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Salvatore Cazzato.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was approved by the Regional Ethics Committee of Marche (reference number 2017-0064 OR).

Informed consent

For this type of study, formal consent is not required.

Additional information

Communicated by Nicole Ritz

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Zallocco, F., Osimani, P., Carloni, I. et al. Assessment of clinical outcome of children with sepsis outside the intensive care unit. Eur J Pediatr 177, 1775–1783 (2018). https://doi.org/10.1007/s00431-018-3247-2

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  • DOI: https://doi.org/10.1007/s00431-018-3247-2

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