Dear Dr. Tangredi:

Dr.s Laura Chapman, Sue Duffy, I and our nursing colleagues at Hasbro/
Brown are happy to share our fairly new screening tool and protocol for
pediatric severe sepsis and septic shock, attached, with caveats.

These are constructed from our best understanding of available literature
and consensus guidelines, some of which are referenced in the list below.
 However, our screening tool and protocol have not been formally tested or
validated.

When designing and launching our own protocol, we benefited from the
sharing, knowledge, and experience of other institutions participating in
an ongoing pediatric sepsis quality improvement project of the Children's
Hospital Association.

There are many unanswered questions regarding optimal screening, and you
can see that our protocol, like some other institutions', pivots largely on
tachycardia adjusted for degree of temperature elevation, but does not
include another potentially important SIRS component- tachypnea.  Cruz et
al reported 81% sensitivity for septic shock using when relying on adjusted
tachycardia.  Larsen et al found tachycardia in just 73% of their cases.
 While it is hoped that demographics, vital signs, and/or concerning exam
findings will facilitate rapid identification, it seems there's still work
to do on the design of an optimal screening tool.


Sincerely,


Geoff Capraro, MD, MPH

Some selected references:
SBrierly J, Carcillo JA et al.: Clinical practice parameters for the
hemodynamic  support of pedatric and neonatal septic shock: 2007 updated
from the American College of Critical Care Medicine.  Crit Care Med
2009;37:666-688.
SCruz AT, Perry AM, Williams EA, Graf JM, Wuestner ER, Patel B.  Implementation
of goal-direced therapy for children with suspected sepsis in the emergency
department.  Pediatrics 2011;127;e758 (TX)
SCruz AT, Williams EA, Graf JM, Perry AM, Harbin DE, Wuestner ER,
Patel B.  Test
characteristics of a automated age- and temperature adjusted tachycardia
alert in pediatric septic shock.  PediatrEmer Care 2012:889-894.
SDellinger RP et al. Surviving sepsis campaign: international guidelines
for management of severe sepsis and septic shock: 2012.  Crit Cared Med
2013;41(2):580-637
SGoldstein B, Giroir B, Randolph A and the ICC on Pediatric Sepsis.
International
pediatric sepsis consensus conference: definitions for sepsis and organ
dysfunction in pediatrics.  PediatrCrit Care Med 2005;6:2-8.
SGaines NN, Patel B, Williams EA, Cruz AT.  Etiologies of septic shock in a
pediatric emergency departnent population.PeidatrInfDisJ.2012;31:11:1203-2105
SLarsen GY, Mecham N, Greenberg R.  An emergency department septic shock
protocol and care guideline for children initiated at triage.
Pediatrics.  2011;127:e1585-e1592
(UT)
SPaul R, Neuman MI, Monuteaux MC, Melendez E.  Adherence to PALS sepsis
guidelines and hospital length of stay.  Pediatrics 2012;130:1-8


On Wed, Feb 6, 2013 at 12:30 PM, Angela Tangredi <[log in to unmask]>wrote:

>   We are now required to have a sepsis treatment pathway to implement in
>  the ED.  While there are established pathways for adults (we have one),
> this is somewhat more complicated for children since parameters vary with
> age.
>
>   Does anyone have a protocol that they are willing to share?
>
> Angela M. Tangredi, MD
> St. Luke's/Roosevelt Hospital Center, NYC
> [log in to unmask]
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-- 
Geoff Capraro, MD, MPH
University Emergency Medicine Foundation
Assistant Professor, Emergency Medicine (Pediatric)
Hasbro Children's Hospital/
Warren Alpert School of Medicine of Brown University
Cell Phone: (508) 410-2215

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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                 http://listserv.brown.edu/ped-em-l.html