R Scott Watson1, Luregn J Schlapbach2,3, Luc Morin4, Mark Hall5, Daniela de Souza6,7, Lu Guoping8, Roberto Jabornisky9,10, Nobuaki Shime11, Suchitra Ranjit12, Patricia Gilholm2, Satoshi Nakagawa13, Jerry J Zimmerman1, Lauren R Sorce14,15, Andrew Argent16,17, Niranjan Kissoon18,19, Pierre Tissières4,20. 1. Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington. 2. Child Health Research Centre, and Paediatric Intensive Care Unit, The University of Queensland, and Queensland Children`s Hospital, Brisbane, Australia. 3. Department of Intensive Care and Neonatology, and Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland. 4. Université Paris-Saclay, AP-HP, Pediatric Intensive Care, Bicêtre Hospital, DMU 3 Santé de l'Enfant et de l'Adolescent, Le Kremlin-Bicêtre, France. 5. Nationwide Children's Hospital, Columbus, Ohio. 6. Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil. 7. Hospital Sírio Libanês, São Paulo, Brazil. 8. Children's Hospital of Fudan University, Shanghai, China. 9. Universidad Nacional del Nordeste, Corrientes, Argentina. 10. Red Colaborativa Pediátrica de Latinoamérica (LARed Network). 11. Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan. 12. Apollo Children's Hospital, Chennai, India. 13. National Center for Child Health & Development, Tokyo, Japan. 14. Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois. 15. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 16. Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. 17. University of Cape Town, Cape Town, South Africa. 18. British Columbia Women and Children's Hospital, Vancouver, British Columbia, Canada. 19. The University of British Columbia, Vancouver, British Columbia, Canada. 20. Institute of Integrative Biology of the Cell, CNRS, CEA, Paris Saclay University, Gif-sur-Yvette, France.
Abstract
BACKGROUND AND OBJECTIVES: Definitions for pediatric sepsis were established in 2005 without data-driven criteria. It is unknown whether the more recent adult Sepsis-3 definitions meet the needs of providers caring for children. We aimed to explore the use and applicability of criteria to diagnose sepsis and septic shock in children across the world. METHODS: This is an international electronic survey of clinicians distributed across international and national societies representing pediatric intensive care, emergency medicine, pediatrics, and pediatric infectious diseases. Respondents stated their preferences on a 5-point Likert scale. RESULTS: There were 2835 survey responses analyzed, of which 48% originated from upper-middle income countries, followed by high income countries (38%) and low or lower-middle income countries (14%). Abnormal vital signs, laboratory evidence of inflammation, and microbiologic diagnoses were the criteria most used for the diagnosis of "sepsis." The 2005 consensus definitions were perceived to be the most useful for sepsis recognition, while Sepsis-3 definitions were stated as more useful for benchmarking, disease classification, enrollment into trials, and prognostication. The World Health Organization definitions were perceived as least useful across all domains. Seventy one percent of respondents agreed that the term sepsis should be restricted to children with infection-associated organ dysfunction. CONCLUSIONS: Clinicians around the world apply a myriad of signs, symptoms, laboratory studies, and treatment factors when diagnosing sepsis. The concept of sepsis as infection with associated organ dysfunction is broadly supported. Currently available sepsis definitions fall short of the perceived needs. Future diagnostic algorithms should be pragmatic and sensitive to the clinical settings.
BACKGROUND AND OBJECTIVES: Definitions for pediatric sepsis were established in 2005 without data-driven criteria. It is unknown whether the more recent adult Sepsis-3 definitions meet the needs of providers caring for children. We aimed to explore the use and applicability of criteria to diagnose sepsis and septic shock in children across the world. METHODS: This is an international electronic survey of clinicians distributed across international and national societies representing pediatric intensive care, emergency medicine, pediatrics, and pediatric infectious diseases. Respondents stated their preferences on a 5-point Likert scale. RESULTS: There were 2835 survey responses analyzed, of which 48% originated from upper-middle income countries, followed by high income countries (38%) and low or lower-middle income countries (14%). Abnormal vital signs, laboratory evidence of inflammation, and microbiologic diagnoses were the criteria most used for the diagnosis of "sepsis." The 2005 consensus definitions were perceived to be the most useful for sepsis recognition, while Sepsis-3 definitions were stated as more useful for benchmarking, disease classification, enrollment into trials, and prognostication. The World Health Organization definitions were perceived as least useful across all domains. Seventy one percent of respondents agreed that the term sepsis should be restricted to children with infection-associated organ dysfunction. CONCLUSIONS: Clinicians around the world apply a myriad of signs, symptoms, laboratory studies, and treatment factors when diagnosing sepsis. The concept of sepsis as infection with associated organ dysfunction is broadly supported. Currently available sepsis definitions fall short of the perceived needs. Future diagnostic algorithms should be pragmatic and sensitive to the clinical settings.