The Importance of Early Action in Sepsis Management with Paediatrics

Sepsis is the body’s extreme response to infection. One of the greatest challenges for emergency medicine is recognising paediatric sepsis. Given the time-sensitive nature of sepsis, when sepsis is suspected, it is imperative to initiate early investigations and treatment, otherwise progression could lead to organ failure.

A Case Example

A child was referred into the Emergency Department. The patient had:-

• History of high temperature; • Vomiting; • Tachycardia.

NICE published Sepsis Guidance in 2016 ‘Sepsis Early recognition, diagnosis and early management tool’ which contains a sepsis risk stratification tool for assessing paediatric patients aged between 5-11 years presenting to an acute hospital with suspected sepsis.

In paediatric patients with a suspected diagnosis of sepsis, the NICE stratification tool advises classifying patients into three groups depending on their clinical signs and symptoms:

1. Patients with high-risk criteria;
2. Patients with moderate to high-risk criteria;
3. Patients with low-risk criteria.

Patient management is then advised depending on which group they fall in. The clinical signs and symptoms used for classifying patients include ‘Behaviour, Heart Rate, Respiratory Rate, Capillary refill time, and Reduced Urine Output’.

Despite having relevant risk criteria for sepsis, the patient was not reviewed immediately on arrival at the ED. Antibiotics were not administered until several hours after the patient’s presentation, and the patient later died.

Conclusions

In light of the national guidelines from NICE, TMLEP would like to highlight the following in respect of management of paediatric sepsis:

1. If patients have a suspected sepsis and relevant risk criteria, the patient needs to be reviewed by either a paediatrician or a senior emergency medicine doctor immediately on arrival at the ED;

2. Patients with symptoms need to be frequently reviewed and observed after their presentation to the ED;

3. Blood tests including blood cultures need to be taken from the patient upon presentation to the ED;

4. Patients should receive IV antibiotics within an hour of their arrival at the ED, as recommended in the guidance.

Sepsis can lead to a range of complications. Most critically, it is commonly fatal, particularly if the diagnosis is delayed, or in patients with other significant health problems. Early recognition and interventions as above will give patients the best chance of survival.