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Identification and treatment of paediatric sepsis: getting the balance right
  1. Michael J Carter1,2,
  2. Philippa Anna Stilwell2,
  3. Ruud Gerard Nijman3,
  4. Sarah Eisen2
  1. 1Department of Women and Children’s Health, King’s College London, London, UK
  2. 2Children and Young People’s Services, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3Paediatric Infectious Diseases, Imperial College London, London, UK
  1. Correspondence to Dr Michael J Carter, Department of Women and Children’s Health, King’s College London, Evelina Children’s Hospital, London SE1 7EH, UK; michael.james.carter{at}gmail.com

https://doi.org/10.1136/archdischild-2018-314865

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    Introduction

    Recent National Institute for Health and Care Excellence (NICE) guidance on sepsis1 defines clinical criteria to guide the management of a child presenting with suspected infection (table 1). In children with suspected infection, presence of a ‘high-risk’ criterion should lead to intravenous access, parenteral antibiotic administration and consideration of intravenous fluid boluses, unless a senior decision-making doctor (DMD; defined as a Specialist Trainee (ST) 4 paediatrician, or ST4 emergency physician for older children) makes an alternative diagnosis.

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    Table 1

    Summarised criteria for stratifying risk of severe illness or death from sepsis in children <12 years of age1

    Since clinical screening criteria for sepsis are non-specific,2 many children without sepsis may receive antibiotic treatment for each case of true sepsis. NICE guidance might unintentionally exacerbate this, diverting …

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    Footnotes

    • Contributors All authors conceived the audit. Implementation of sepsis pathways and education was led by SE. Data collection was done by MJC, PAS, RGN and SE. Data analysis was done by MJC and RGN.

    • Funding Support for this study was through an NIHR Academic Clinical Lectureship to Michael Carter.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Unpublished data may be made available in anonymised format to interested researchers by contacting SE and following review by UCL Hospitals NHS Foundation Trust.