Halden F Scott1, Emily E Greenwald2, Lalit Bajaj3, Sara J Deakyne Davies4, Lina Brou5, Allison Kempe6. 1. Department of Pediatrics, University of Colorado, Aurora, CO; Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado, Aurora, CO. Electronic address: Halden.scott@childrenscolorado.org. 2. Department of Pediatrics, University of Colorado, Aurora, CO; Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado, Aurora, CO. 3. Department of Pediatrics, University of Colorado, Aurora, CO; Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado, Aurora, CO; Center for Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO; Research Informatics, Children's Hospital Colorado, Aurora, CO. 4. Research Informatics, Children's Hospital Colorado, Aurora, CO. 5. Department of Pediatrics, University of Colorado, Aurora, CO. 6. Department of Pediatrics, University of Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, CO.
Abstract
OBJECTIVES: To assess whether the risk of missed clinician diagnosis of pediatric sepsis requiring care in the intensive care unit (ICU) was greater in community vs tertiary pediatric emergency care settings with sepsis pathways. STUDY DESIGN: An observational cohort study in a tertiary pediatric emergency department (ED) staffed by pediatric emergency physicians and 4 affiliated community pediatric ED/urgent care sites staffed by general pediatricians. Use of an institutional sepsis order set or pathway was considered clinician diagnosis of sepsis. Risk of missed diagnosis was compared for 2 outcomes: suspected infection plus ICU admission (sepsis-ICU) and suspected infection plus vasoactive agent/positive-pressure ventilation (sepsis-VV). RESULTS: From January 1, 2014 to December 31, 2015, there were 141 552 tertiary and 139 332 community emergency visits. Clinicians diagnosed sepsis in 1136 visits; median age was 5.7 (2.4, 12.0) years. In the tertiary ED, there were 306 sepsis-ICU visits (0.2%) and 112 sepsis-VV visits (0.08%). In community sites, there were 46 sepsis-ICU visits (0.03%) and 20 sepsis-VV visits (0.01%). The risk of missed diagnosis in community vs tertiary sites was significantly greater for sepsis-ICU (relative risk 4.30, CI 2.15-8.60) and sepsis-VV (relative risk 14.0, CI 2.91-67.24). Sensitivity for sepsis-ICU was 94.4% (91.3%-96.5%) at the tertiary site and 76.1% (62.1%-86.1%) at community sites. CONCLUSIONS: The risk of missed diagnosis of sepsis-ICU was greater in community vs tertiary emergency care settings despite shared pathways and education, but with differences in resources, providers, and sepsis incidence. More research is needed to optimize diagnostic approaches in all settings.
OBJECTIVES: To assess whether the risk of missed clinician diagnosis of pediatric sepsis requiring care in the intensive care unit (ICU) was greater in community vs tertiary pediatric emergency care settings with sepsis pathways. STUDY DESIGN: An observational cohort study in a tertiary pediatric emergency department (ED) staffed by pediatric emergency physicians and 4 affiliated community pediatric ED/urgent care sites staffed by general pediatricians. Use of an institutional sepsis order set or pathway was considered clinician diagnosis of sepsis. Risk of missed diagnosis was compared for 2 outcomes: suspected infection plus ICU admission (sepsis-ICU) and suspected infection plus vasoactive agent/positive-pressure ventilation (sepsis-VV). RESULTS: From January 1, 2014 to December 31, 2015, there were 141 552 tertiary and 139 332 community emergency visits. Clinicians diagnosed sepsis in 1136 visits; median age was 5.7 (2.4, 12.0) years. In the tertiary ED, there were 306 sepsis-ICU visits (0.2%) and 112 sepsis-VV visits (0.08%). In community sites, there were 46 sepsis-ICU visits (0.03%) and 20 sepsis-VV visits (0.01%). The risk of missed diagnosis in community vs tertiary sites was significantly greater for sepsis-ICU (relative risk 4.30, CI 2.15-8.60) and sepsis-VV (relative risk 14.0, CI 2.91-67.24). Sensitivity for sepsis-ICU was 94.4% (91.3%-96.5%) at the tertiary site and 76.1% (62.1%-86.1%) at community sites. CONCLUSIONS: The risk of missed diagnosis of sepsis-ICU was greater in community vs tertiary emergency care settings despite shared pathways and education, but with differences in resources, providers, and sepsis incidence. More research is needed to optimize diagnostic approaches in all settings.
Authors: Emily Greenwald; Elizabeth Olds; Jan Leonard; Sara J Deakyne Davies; Julia Brant; Halden F Scott Journal: Pediatr Emerg Care Date: 2021-12-01 Impact factor: 1.454
Authors: Halden F Scott; Richard J Brilli; Raina Paul; Charles G Macias; Matthew Niedner; Holly Depinet; Troy Richardson; Ruth Riggs; Heidi Gruhler; Gitte Y Larsen; W Charles Huskins; Fran Balamuth Journal: Crit Care Med Date: 2020-10 Impact factor: 9.296
Authors: Halden F Scott; Allison Kempe; Sara J Deakyne Davies; Paige Krack; Jan Leonard; Elise Rolison; Joan Mackenzie; Beth Wathen; Lalit Bajaj Journal: Pediatr Qual Saf Date: 2020-01-11