Responses

Download PDFPDF
Letter
Identifying paediatric sepsis: the difficulties in following recommended practice and the creation of our own pathway
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Response to e-letter regarding Primary Care screening tool
    • Kerry Jeavons, Paediatric Consultant and Leeds Children's Hospital Quality lead Leeds Children's Hospital

    We thank Luamar Dolfini and Gabriella Williamson for noting the sepsis screening tool that we developed in Leeds. Our tool was based on the NICE guidance, but used local early warning scores (PAWS) to simplify the assessment risk for sepsis. At Leeds Children's Hospital our tool is used on all acute paediatric admissions and in any child that deteriorates on the paediatric wards. Since our initial letter was published in 2018, our team have further amended our screening tool in response to human factors work, and have introduced the acronym LEEDS (Look for sepsis is all acute admissions or children who deteriorate: Evaluate the risk of sepsis by completing the sepsis screening tool; Escalate to a senior decision maker to consider the risk of sepsis; Decide whether there is a high/medium/low risk of sepsis using clinical assessment and investigations such as lactate; Start antibiotics in under 60 minutes if sepsis is a possibility). Our team have found the paper by Roland and Snelson ("So why didn't you think this baby was ill?" Decision-making in acute paediatrics, Arch Dis Educ Pract Ed 2019; 104:43-48) invaluable in educating our team about making decisions and assessing risk and this e-letter highlights that all parts of the puzzle (e.g. a full and comprehensive set of observations) are essential in being able to appropriately risk stratify patients, including for sepsis.

    Conflict of Interest:
    None declared.
  • Published on:
    Identifying paediatric sepsis: audit of the assessment of children aged
    • Luamar S Dolfini, Medical Student St Georges University of London
    • Other Contributors:
      • Gabriella Williamson, Medical Student

    Powell and Jeavons undertook a hospital-based audit(1) comparing the new guidelines for identifying paediatric sepsis(2) to previous cases that had attended the emergency department. By contrast, our recent sepsis audit investigating the assessment of under 5s with fever ≥37.5°C (before possible referral to hospital) was done in primary care.

    The National Institute for Health and Care Excellence (NICE) guidelines for sepsis assessment outlines four signs that should be recorded: temperature, pulse, respiratory rate and capillary refill time. An initial audit looking at compliance to these guidelines was conducted looking at data in computerised records from May 2014 – May 2018 at an inner-city general practice. Results showed that in only 15% of 111 consecutive consultations with feverish children aged <5 were all four signs recorded. More specifically, pulse was recorded in 81%, respiratory rate in 49%, and capillary refill time in only 32% of consultations.

    Following presentation of these findings to the general practitioners and practice nurses, a re-audit was undertaken assessing 48 consecutive consultations from June 2018 – June 2019. Results showed a slight improvement from 15% to 25% of consultations recording all four signs, with 94% of consultations recording pulse, 42% recording respiratory rate, and 50% recording capillary refill time.

    Powell and Jeavons have now created a simple ED paediatric sepsis pathway to minimise unnecessary inv...

    Show More
    Conflict of Interest:
    None declared.