Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia

Abstract

Objective: The Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.

Design: Prospective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds.

Setting: Twelve emergency departments (EDs) in Queensland, Australia.

Participants: 3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis.

Interventions: A 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination.

Primary outcome measure: Senior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED.

Results: The 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results.

Conclusions: A simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis.

Keywords: INFECTIOUS DISEASES; PAEDIATRICS; Quality in health care.

Figure 1

Receiver operating characteristic (ROC) curves are shown for the models for each of four blocks contained in the sepsis screening tool, and for the final model, validated using 10-fold cross-validation.