Development, Implementation, and Evaluation of an Early Sepsis Screening Tool at Triage in a Pediatric Emergency Department in Latin America.

OBJECTIVE

Sepsis screening tools in Pediatric Emergency Departments (PEDs) enable timely alerts and treatment. This study aimed to develop, implement, and evaluate a sepsis screening tool applied during triage in patients with fever or hypothermia in a PED.

METHODS

The study was conducted in 3 phases (design, implementation, and evaluation) from July 1, 2023, to July 31, 2024. The screening tool included the Pediatric Assessment Triangle (PAT), parental concern, critical appearance, vital signs, mental status, skin condition, capillary refill, and risk factors, with results classified as positive or negative. Evaluation followed an observational, prospective diagnostic test design using 3 reference standards: intention-to-treat standard, Phoenix criteria, and final diagnosis at case closure. Patients aged >28 days to <18 years with fever or hypothermia were included. Results were analyzed for diagnostic accuracy (sensitivity, specificity, predictive values, and likelihood ratios). Additional analyses were performed to examine the triggers of positive alerts and causes of missed alerts.

RESULTS

During the evaluation period, 16,771 of 40,005 PED patients had fever or hypothermia. The tool was positive in 1.4% (240/16,672). These patients had significantly more triage levels I and II (99.6% vs. 4.8%), higher hospitalization rates (66% vs. 5%), pediatric intensive care unit admissions (11% vs. 0.03%), and mortality (3.8% vs. 0.01%). For sepsis at case closure, the tool showed sensitivity of 0.80, specificity of 0.99, positive predictive value of 0.33, negative predictive value of 1, positive likelihood ratio of 84, and negative likelihood ratio of 0.20. Circulatory alteration in the PAT [odds ratio (OR): 2.8], abnormal capillary refill (OR: 1.9), and critical risk factors (OR: 2.1) independently increased the risk of sepsis.

CONCLUSIONS

The sepsis screening tool evaluated demonstrated good performance in detecting sepsis in the PED. Circulatory alteration in the PAT, abnormal capillary refill, and presence of a critical risk factor were key sepsis predictors.