Pediatric Series: Sepsis Identification
Identifying Sepsis in the Pediatric Population
There is still debate on the definition of sepsis in pediatrics given the varying vital signs for ages and how sepsis presents differently in pediatric patients than in our adult patients. Over the last decade, researchers have identified the lapse in data about pediatric sepsis, and there are now sets of criteria to help clinicians diagnose sepsis in our younger patients. This is important to clinicians because research has shown that quickly identifying sepsis and implementing the appropriate resuscitation has a significant decrease in mortality in septic children.
The systemic inflammatory response syndrome (SIRS) is defined as a pediatric patient who has a temperature abnormality (either fever or hypothermia) OR leukocytosis/leukopenia AND one of the following: tachycardia, bradycardia, respiratory distress, or conditional requiring mechanical ventilation. If a child meets SIRS criteria and has suspected or proven infection, they meet the definition of sepsis. Unlike adults, hypotension may not present in children until much later. Hypotension is not necessary to diagnose septic shock in the pediatric population.
Not every tachycardic child with a fever is septic, and tachycardia is a very nonspecific finding. In febrile children, for every 1°C elevation in body temperature, a child's heart rate may increase by 10 beats/minute. While tachycardia will likely be present in febrile patients, tachycardia should improve as fever defervesces. Persistent tachycardia is a red flag of a more sinister underlying process. Bradycardia is defined as a mean heart rate less than the 10th percentile when adjusted for age.
In summary, although sepsis presents differently in our pediatric population, research over the last decade has helped delineate what presentations are found in a septic child. These definitions help clinicians resuscitate septic children more efficiently and can reduce mortality associated with unidentified and untreated sepsis.
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensusconference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2–8.
Pomerantz, W., & Weiss, S. (2019). Systemic inflammatory response syndrome (SIRS) and sepsis in children: Definitions, epidemiology, clinical manifestations, and diagnosis. Retrieved September 8, 2019, from https://www.uptodate.com/contents/systemic-inflammatory-response-syndrome-sirs-and-sepsis-in-children-definitions-epidemiology-clinical-manifestations-and-diagnosis?topicRef=85767&source=see_link#H2745623