Improving admission of children with life-threatening infections

September 30, 2020

Identifying febrile children who have a life-threatening infection in an emergency department isn’t easy. An investigation looks at whether a new assessment can improve that identification.

For children taken to the emergency department with a fever, identifying a life-threatening infection is one of the highest priorities, however, it can be difficult to do. The quick Sequential Organ Failure Assessment, which can help with this identification of such infections, was meant for adult patients and there was no pediatric score. A report in Pediatrics looks at how an adapted version of the quick Sequential Organ Failure Assessment performed in predicting critical care admissions.1

The Liverpool quick Sequential Organ Failure Assessment developed by the researchers utilized age-adjusted heart rate, respiratory rate, capillary refill, and consciousness level on the Alert, Voice, Pain, Unresponsive scale. Its performance was compared to the quick Sequential Organ Failure Assessment, Pediatric Early Warning Score, and National Institute for Health and Care Excellence high-risk criteria. The researchers’ primary outcome was a critical care admission within 48 hours of presenting to the emergency department and the secondary outcome was mortality related to sepsis.

Within the first cohort (n = 1121), there were 47 critical care admissions and in the validation cohort (n = 12 241), there were 135 critical care admissions and 5 sepsis-related deaths. The investigators found that in the validation cohort, that the Liverpool quick Sequential Organ Failure Assessment predicted critical care admission with an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.76 to 0.86). In comparison, the quick Sequential Organ Failure Assessment was 0.66 (95% CI, 0.60 to 0.71); Pediatric Early Warning Score was 0.93 (95% CI, 0.90 to 0.95); and National Institute for Health and Care Excellence high-risk criteria was 0.81 (95% CI, 0.78 to 0.85). Additionally, the Liverpool quick Sequential Organ Failure Assessment performed better than the quick Sequential Organ Failure Assessment when predicting critical care admission, with a net reclassification index of 10.4% (95% CI, 1.0% to 19.9%).

The investigators concluded that their large study had demonstrated that the Liverpool quick Sequential Organ Failure Assessment performed better than the quick Sequential Organ Failure Assessment in identifying children with a fever who were at risk of critical care admission and sepsis-related mortality. They also stated that further study to validate the assessment in other setting is needed.

Reference

1. Romaine S, Potter J, Khanijau A et al. Accuracy of a modified qSOFA score for predicting critical care admission in febrile children. Pediatrics. September 25, 2020. Epub ahead of print. doi:10.1542/peds.2020-0782