Determining predictors of sepsis at triage among children under 5 years of age in resource-limited settings: A modified Delphi process.

Jollee S T Fung,Mike English,Matthew O Wiens,J Mark Ansermino,Samuel Akech,Niranjan Kissoon,Marleen Smits

doi:10.1371/journal.pone.0211274

Abstract

Sepsis is a life-threatening dysfunction of the immune system leading to multiorgan failure that is precipitated by infectious diseases and is a leading cause of death in children under 5 years of age. It is necessary to be able to identify a sick child at risk of developing sepsis at the earliest point of presentation to a healthcare facility so that appropriate care can be provided as soon as possible. Our study objective was to generate a list of consensus-driven predictor variables for the derivation of a prediction model that will be incorporated into a mobile device and operated by low-skilled healthcare workers at triage. By conducting a systematic literature review and examination of global guideline documents, a list of 72 initial candidate predictor variables was generated. A two-round modified Delphi process involving 26 experts from both resource-rich and resource-limited settings, who were also encouraged to suggest new variables, yielded a final list of 45 predictor variables after evaluating each variable based on three domains: predictive potential, measurement reliability, and level of training and resources required. The final list of predictor variables will be used to collect data and contribute to the derivation of a prediction model.

Highlights

Infectious diseases, primarily pneumonia, malaria, and diarrheal illnesses, constitute the major causes of post-neonatal deaths in children younger than 5 years of age [1]
Prediction can be elusive without appreciation of the myriad of signs and symptoms triggered by infections that could signify the evolution of sepsis in a sick child
References of articles were screened for potentially eligible manuscripts. This process identified 12 manuscripts that were used in this study, along with 3 publications from World Health Organization (WHO) and the South African Triage Scale developed by the Emergency Medicine Society of South Africa

Summary

Introduction

Infectious diseases, primarily pneumonia, malaria, and diarrheal illnesses, constitute the major causes of post-neonatal deaths in children younger than 5 years of age [1]. Current guidelines aimed at identifying “danger signs” in children, such as the Integrated Management of Childhood Illness and Emergency Triage Assessment and Treatment manuals published by WHO, require healthcare workers to screen for signs of distress such as chest in-drawing and weak and fast pulses [9,10]. As such guidelines were largely developed from expert opinion, the predictive ability of each sign and symptom used remains to be evaluated in a systematic manner. A short delay in antibiotic administration can significantly increase mortality in patients with sepsis [11, 12]

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Results

Discussion

Conclusion