Abstract
To quantify a qualitative screening tool for the early recognition of sepsis in children with fever either visiting the emergency department or already admitted to hospital. Prospective observational study including febrile patients under 18 years of age. Sepsis diagnosis was the main outcome. A multivariable analysis was performed with 4 clinical variables (heart rate, respiratory rate, disability, and poor skin perfusion). The cut-off points, odds ratio, and coefficients of these variables were identified. The quantified tool was then obtained from the coefficients. The area under the curve (AUC) was obtained and internal validation was performed using k-fold cross-validation. Two hundred sixty-six patients were included. The multivariable regression confirmed the independent association of the 4 variables with the outcome. The quantified screening tool yielded an excellent AUC, 0.825 (95%CI 0.772–0.878, p < 0.001), for sepsis prediction.
Conclusion: We successfully quantified a sepsis screening tool, and the resulting model has an excellent discriminatory power.
What is Known: |
• Screening tests have to be based only on clinical variables that needs minimum technological support. |
• The current Sepsis Code is a qualitative screening tool. |
What is New: |
• The current screening tool was quantified using four clinical variables, weighted according to the deviation from normality and differentiated according to the age of the patient. |
• The resulting model has an excellent discriminatory power in identifying septic patients among febrile pediatric patients. |
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Abbreviations
- AUC:
-
Area under the curve
- CI:
-
Confidence interval
- ED:
-
Emergency department
- IQR:
-
Interquartile range
- NPV:
-
Negative predictive value
- PESERS score:
-
PEdiatric SEpsis Recognition and Stratification score
- PPV:
-
Positive predictive value
- qSOFA score:
-
Quick Sequential Organ Failure Assessment Score
- Se:
-
Sensitivity
- SIRS:
-
Systemic inflammatory response syndrome
- SOFA:
-
Sequential Organ Failure Assessment Score
- Sp:
-
Specificity
- UCI:
-
Intensive care unit
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A. Solé-Ribalta conceptualised and designed the study, designed the data collection instrument, collected the data, carried out the initial analysis, and drafted the initial manuscript. M. Balaguer, S. Bobillo- Pérez, M. Girona Alarcón, and C. Guitart contributed to the data collection and analysis. E. Esteban and I. Jordan conceptualised and designed the study and critically reviewed the manuscript. All the authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The study and its database were approved and declared safe by the Hospital Sant Joan de Déu ethics committee and by the institutional review board. The study followed the principles of the Declaration of Helsinki.
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Parents or legal guardians of children younger than 12 years old were required to sign the informed consent document before their children were included. Participants older than 12 years had to sign an additional informed consent in addition to the one signed by their legal guardians.
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Parents or legal guardians of children younger than 12 years old were required to sign the informed consent document before their children were included. Participants older than 12 years had to sign an additional informed consent in addition to the one signed by their legal guardians.
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Communicated by H. Babaie.
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Solé-Ribalta, A., Balaguer, M., Bobillo-Pérez, S. et al. Quantification of a qualitative sepsis code: laying the foundations for the automation revolution. Eur J Pediatr 182, 2169–2172 (2023). https://doi.org/10.1007/s00431-023-04867-8
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DOI: https://doi.org/10.1007/s00431-023-04867-8