An electronic sepsis alert using a combination of vital signs, risk factors and physician judgment to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76 percent. The results of the study, along with an accompanying editorial, were published online Friday in Annals of Emergency Medicine ("Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification" and "Between the Devil and the Deep Blue Sea: Use of Real-Time Tools to Identify Children with Severe Sepsis in the Pediatric Emergency Department").
A study published in Annals of Emergency Medicine shows new protocol reduces missed sepsis diagnoses in children by 76 percent. Courtesy of American College of Emergency Physicians
An electronic sepsis alert using a combination of vital signs, risk factors and physician judgment to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76 percent. The results of the study, along with an accompanying editorial, were published online Friday in Annals of Emergency Medicine ("Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification" and "Between the Devil and the Deep Blue Sea: Use of Real-Time Tools to Identify Children with Severe Sepsis in the Pediatric Emergency Department").
"Sepsis is a killer and notoriously difficult to identify accurately in children, which is why this alert is so promising," said lead study author Fran Balamuth, MD, PhD, MSCE, of Children's Hospital of Philadelphia, in Philadelphia. "Identifying the rare child with severe sepsis or septic shock among the many non-septic children with fever and tachycardia in a pediatric ER is truly akin to finding the proverbial 'needle in a haystack.' This alert, especially with the inclusion of physician judgment, gets us much closer to catching most of those very sick children and treating them quickly."
Researchers built a two-stage alert (ESA) and implemented it into the hospital's electronic health record (EHR). The first-stage alert is triggered when an age-based elevated heart rate or hypotensive blood pressure is documented in the EHR at any time during the emergency visit. If the patient also has a fever or risk of infection, the alert triggers a series of questions about underlying high risk conditions, perfusion and mental status. The second-stage alert triggers if there is an affirmative answer to any of these questions. When patients have positive first- and second- stage alerts, a "sepsis huddle" is triggered, which is a brief, focused patient evaluation and discussion with the treatment team, including the emergency physician.
"Clinical identification remains critically important to making this protocol successful in identifying and treating these sick children," said Balamuth.
Of the 1.2 percent of the patients with positive ESAs, 23.8 percent had positive huddles and were placed on the sepsis protocol. The protocol missed 4 percent of patients who later went on to develop severe sepsis, which researchers attribute to "patient complexity," especially among patients with developmental delays.
The accompanying editorial, by Andrea Cruz, MD, MPH of the Baylor College of Medicine in Houston, Texas states: "This ESA advances the field of sepsis recognition by integrating vital sign anomalies, comorbidities that increase a child's risk for sepsis, and clinical judgment into a tool that is both more sensitive and specific than prior alerts as well as less prone to alert fatigue."
Source: American College of Emergency Physicians
How Contaminated Is Your Stretcher? The Hidden Risks on Hospital Wheels
July 3rd 2025Despite routine disinfection, hospital surfaces, such as stretchers, remain reservoirs for harmful microbes, according to several recent studies. From high-touch areas to damaged mattresses and the effectiveness of antimicrobial coatings, researchers continue to uncover persistent risks in environmental hygiene, highlighting the critical need for innovative, continuous disinfection strategies in health care settings.
Beyond the Surface: Rethinking Environmental Hygiene Validation at Exchange25
June 30th 2025Environmental hygiene is about more than just shiny surfaces. At Exchange25, infection prevention experts urged the field to look deeper, rethink blame, and validate cleaning efforts across the entire care environment, not just EVS tasks.
A Controversial Reboot: New Vaccine Panel Faces Scrutiny, Support, and Sharp Divides
June 26th 2025As the newly appointed Advisory Committee on Immunization Practices (ACIP) met for the first time under sweeping changes by HHS Secretary Robert F. Kennedy Jr, the national spotlight turned to the panel’s legitimacy, vaccine guidance, and whether science or ideology would steer public health policy in a polarized era.