Journal of Pediatric Infectious Diseases 2020; 15(01): 039-047
DOI: 10.1055/s-0039-1698442
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pediatric Sepsis in Our Community: A Point Prevalence Study

1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
Frank Carnevale
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
2  Department of Emergency Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
,
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
Bree Kramer
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
Vanessa Marthia
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
Kirsten Nutty
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
Nikhil Patankar
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
3  Beacon Children’s Hospital Critical Kids, Indiana University School of Medicine, South Bend, Indiana, United States
,
Scott Wilkowski
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
,
Amanda B. Hassinger
1  Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
› Author Affiliations
Funding None.
Further Information

Publication History

14 January 2019

26 August 2019

Publication Date:
21 October 2019 (online)

Abstract

Objective Hospital-based studies are the main sources of epidemiologic data on pediatric sepsis, underrepresenting those managed as outpatients. This may disadvantage community providers, especially when determining triage, referral, and follow-up. Our objective was to characterize sepsis in nonhospitalized children and describe resources allocated to their care.

Methods This was a point prevalence study conducted in 11 primary care (PC) offices, 2 urgent care (UC) centers, and 1 pediatric emergency department (ED) serving Western New York. Patients aged 18 years and younger evaluated at a participating site on one of four study dates over a 12-month period were eligible to participate. Patients were included if temperature and heart rate and/or respiratory rate were documented during their visit. The primary outcome was the prevalence of sepsis in participating sites.

Results Of 3,269 eligible children, 52.6% (n = 1,719) met inclusion criteria, 91% of whom (n = 1,576) were evaluated for acute infection. Sepsis criteria were met by 8.8% of these patients (22.4% in ED, 13.0% in UC centers, and 1.6% in PC offices). Most (74%) patients with sepsis were managed solely by initial site and sent home. However, meeting sepsis criteria was associated with higher odds of escalation of care beyond initial site (adjusted odds ratio [aOR]: 2.59, 95% confidence interval [CI]: 1.62–4.17). The presence of tachycardia (aOR: 2.88, 95% CI: 1.70–4.90) or a lower respiratory tract infection (aOR: 3.69, 95% CI: 2.28–5.99) was also independently associated with higher odds of care escalation.

Conclusion Nearly 1 in 10 children seeking outpatient evaluation for infection met sepsis criteria. While most were managed without transfer or hospital admission, the diagnosis did carry higher odds of care escalation. Tachycardia and lower respiratory tract infections also conveyed an increased likelihood, suggesting additional screening possibilities for outpatient clinicians.

Supplementary Material