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@article{Nijman:2020:10.3389/fped.2020.548154,
author = {Nijman, R and Joergensen, R and Levin, M and Herberg, J and Maconochie, I},
doi = {10.3389/fped.2020.548154},
journal = {Frontiers in Pediatrics},
pages = {1--17},
title = {Management of children with fever at risk for paediatric sepsis: a prospective study in paediatric emergency care},
url = {http://dx.doi.org/10.3389/fped.2020.548154},
volume = {8},
year = {2020}
}

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TY  - JOUR
AB  - Objective: To study warning signs of serious infections in febrile children presenting to PED, ascertain their risk of having sepsis, and evaluate their management.Design: Prospective observational study.Setting: A single pediatric emergency department (PED).Participants: Febrile children, aged 1 month−16 years, with >= 1 warning signs of sepsis.Interventions and Main outcome measures: Clinical characteristics, including different thresholds for tachycardia and tachypnoea, and their association with (1) delivery of pediatric sepsis 6 (PS6) interventions, (2) final diagnosis of invasive bacterial infection (IBI), (3) the risk for pediatric intensive care unit (PICU) admission, and (4) death.Results: Forty-one percent of 5,156 febrile children had warning signs of sepsis. 1,606 (34%) children had tachypnoea and 1,907 (39%) children had tachycardia when using APLS threshold values. Using the NICE sepsis guidelines thresholds resulted in 1,512 (32%) children having tachypnoea (kappa 0.56) and 2,769 (57%) children having tachycardia (kappa 0.66). Of 1,628 PED visits spanning 1,551 disease episodes, six children (0.4%) had IBI, with one death (0.06%), corresponding with 256 children requiring escalation of care according to sepsis guideline recommendations for each child with IBI. There were five additional PICU admissions (0.4%). 121 (7%) had intravenous antibiotics in PED; 39 children (2%) had an intravenous fluid bolus, inotrope drugs were started in one child. 440 children (27%) were reviewed by a senior clinician. In 4/11 children with IBI or PICU admission or death, PS6 interventions were delivered within 60 min after arriving. 1,062 (65%) visits had no PS6 interventions. Diagnostic performance of vital signs or sepsis criteria for predicting serious illness yielded a large proportion of false positives. Lactataemia was not associated with giving iv fluid boluses (p = 0.19) or presence of serious bacterial infections (p = 0.128).Conclusion: Many febrile chi
AU  - Nijman,R
AU  - Joergensen,R
AU  - Levin,M
AU  - Herberg,J
AU  - Maconochie,I
DO  - 10.3389/fped.2020.548154
EP  - 17
PY  - 2020///
SN  - 2296-2360
SP  - 1
TI  - Management of children with fever at risk for paediatric sepsis: a prospective study in paediatric emergency care
T2  - Frontiers in Pediatrics
UR  - http://dx.doi.org/10.3389/fped.2020.548154
UR  - https://www.frontiersin.org/articles/10.3389/fped.2020.548154/full
UR  - http://hdl.handle.net/10044/1/82340
VL  - 8
ER  -

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