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Evaluation of a novel approach to recognising community-acquired paediatric sepsis at ED triage by combining an electronic screening algorithm with clinician assessment
  1. Sylvester Gomes1,
  2. Darryl Wood2,
  3. Salma Ayis3,
  4. Nikolaos Haliasos2,
  5. Damian Roland4,5
  1. 1Paediatric Emergency Department, Evelina London Children's Hospital, London, UK
  2. 2Emergency Department, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, London, UK
  3. 3Medical Statistics, King's College London, London, UK
  4. 4Health Sciences, University of Leicester, Leicester, UK
  5. 5Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK
  1. Correspondence to Dr Sylvester Gomes, Paediatric Emergency Department, Evelina London Children's Hospital, London SE1 7EH, UK; sylvestergomes{at}gmail.com

Abstract

Objective We report the utilisation and impact of a novel triage-based electronic screening tool (eST) combined with clinical assessment to recognise sepsis in paediatric ED.

Methods An electronic sepsis screening tool was implemented in the paediatric EDs of two large UK secondary care hospitals between June 2018 and January 2019. Patients eligible for screening were children < 16 years of ages excluding those with minor injuries or who were brought directly to resuscitation. Subsequently, a retrospective evaluation was performed to determine the performance of the tool alone and in combination with clinical assessment after triage, to identify septic patients, using sensitivity, specificity, positive, negative predictive values (PPV and NPV) and likelihood ratios.

Results 19 912 children were triaged during the study period, of whom 90 (0.45%) were classified as having sepsis. 99% of all eligible patients were screened. The eST alerted for 2651 (13.3%) patients. After immediate physician assessment, 151 were treated for sepsis in the ED, of whom 70 had a final diagnosis of sepsis. Eight patients who were not thought to be septic returned with sepsis within 24 hours. The eST showed a sensitivity of 86.7% (95% CI 77.5% to 92.6%), specificity 87.0% (95% CI 86.5% to 87.5%), PPV 2.94% (95% CI 2.35% to 3.68%), NPV 99.9% (95% CI 99.8% to 99.9%) which improved with combined clinical assessment to a sensitivity of 90.0% (95% CI 81.4% to 95.0%), specificity 99.4 (95% CI 99.3% to 99.5%), PPV 42.0 (95% CI 35.0% to 49.3%) and NPV 99.9% (95% CI 99.9% to 99.9%).

Conclusion Utilisation of a novel triage-based eST allowed sepsis screening in over 99% of eligible patients. The screening tool showed good accuracy to recognise sepsis at triage in the ED, which was augmented further by combining it with clinician assessment. The screening tool requires further refinement through multicentre evaluation to avoid missing sepsis cases.

  • paediatrics
  • paediatric emergency medicine
  • triage
  • infection
  • quality improvement
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Footnotes

  • Handling editor Roland Merchant

  • Twitter @Sylvester_PED, @damian_roland

  • Contributors SG: conceptualising study design, drafting, reviewing preparing the manuscript. DR: critically reviewed the study proposal contributed extensively towards revisions. DW: independent review of data and contributed to writing the draft manuscript. SA: statistical calculations. NH: AI concepts in early draft.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was designed as a service evaluation and approved by the hospital Research and Innovation Department and registered under the category Audit & Quality Improvement (Ref: 1045).

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

  • Data availability statement Data are available upon reasonable request. Anonymised data can be shared upon reasonable request for research driven purposes, as secure electronic files, with the appropriate Research & Development & Information Governance approvals.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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