Frailty of paediatric sepsis tools.

Abstract

Journal of Paediatrics and Child HealthEarly View Heads UpFree Access Frailty of paediatric sepsis tools First published: 16 February 2023 https://doi.org/10.1111/jpc.16379 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Sepsis screening tools were introduced to facilitate early recognition of sepsis in children. The tools, based on physiological parameters, are known to have a low positive predictive value. In their study in The Journal of Paediatrics and Child Health, Damian Roland and colleagues analyse trends in physiological parameters in acute care settings. This study has important implications in revealing the frailty of sepsis tools when applied to a population of unwell children especially in those under 5 with labile physiological responses. The study (Fig 1) shows that the specificity of heart and respiratory rate is particularly low in children under 5 and increases with age.1 A large proportion of children who trigger as suspected sepsis are under 5 and may be overtreated resulting in poor antimicrobial stewardship. Underestimation of sepsis/serious illness in children can also occur secondary to sepsis fatigue. Fig. 1Open in figure viewerPowerPoint 5th to 95th centile of the study and APLS for heart and respiratory rate. We may need to accept that the perfect screening tool for paediatric sepsis is unlikely to exist. While there has been a drive to implement sepsis screening tools in acute care settings for children, the physiological parameters on which they are based need revision as unwell children, with self-limiting disease, often present with abnormal observations. Clinical acumen remains key. Reference 1Brennan L, Heal C, Brown S, Roland D, Rowland AG. Time to change the reference ranges of children's physiological observations in emergency care? A prospective study. J. Paediatr. Child Health 2023 (Epub ahead of print). https://doi.org/10.1111/jpc.16328. Reviewer: Caroline Ponmani, caroline.ponmani@nhs.net, Department of Paediatric Emergency Medicine, Barking Havering and Redbridge University Trust, London UK Early ViewOnline Version of Record before inclusion in an issue FiguresReferencesRelatedInformation