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Which features show us a child is not septic?
Background: Paediatric sepsis guidelines and decision aids are numerous, but tend to focus (rightly) on maximum sensitivity so no septic child is missed. There is of course a risk of over-diagnosis and over-treatment, but in real life we instinctively use features of wellness to reassure us that a child does not have sepsis. This gestalt develops throughout a doctor's career and can be difficult to pin down and analyse. This paper attempted to do just that by gathering expert opinion to identify a consensus on which features reduce the probability of sepsis.
Snelson E, Ramlakhan S. Which observed behaviours may reassure physicians that a child is not septic? An international Delphi study. Arch Dis Child 2018;103:864-867
The paper: A modified Delphi technique was used to survey nearly 200 paediatric consultants in two rounds with the question: "What activities or behaviours do you feel are reassuring and significantly reduce the likelihood that a febrile child has possible sepsis?" Three behaviours were reported as reassuring by over 90% of respondents: 1. Being actively energetic (e.g. running, jumping or similar)2. Being talkative, chatty, babbling or cooing (age appropriate)3. Playing4. Eating (>70%)The least reassuring behaviours were showing fear of the clinician and using an electronic device ('iPhone positive' may not be a reliable sign in kids)
The bottom line: This is the first attempt at defining wellness in febrile children. It suggests that being energetic, talkative, playing and eating are reassuring features that contribute to clinician gestalt.
Expert commentary:"This is a very interesting study, something we constantly do in Paediatric ED but something I have difficulty teaching ("Well children look well," is commonly said but is difficult to define). This study shows the importance of looking at the child's behaviour both in a cubical and in the waiting room, and of observing them over time." (Dr Emily Goodlad, Paediatric Consultant)
"I strongly agree with these findings. In kids, even tonsillitis can trigger the 'sepsis 6' protocol. As a paediatrician, seeing the child as a whole - smiling, playing, running around - is vital and helps us to decide the management."(Dr Mohsin Jafri, Paediatric Consultant)
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By Barrie StevensonBackground: Paediatric sepsis guidelines and decision aids are numerous, but tend to focus (rightly) on maximum sensitivity so no septic child is missed. There is of course a risk of over-diagnosis and over-treatment, but in real life we instinctively use features of wellness to reassure us that a child does not have sepsis. This gestalt develops throughout a doctor's career and can be difficult to pin down and analyse. This paper attempted to do just that by gathering expert opinion to identify a consensus on which features reduce the probability of sepsis.
Snelson E, Ramlakhan S. Which observed behaviours may reassure physicians that a child is not septic? An international Delphi study. Arch Dis Child 2018;103:864-867
The paper: A modified Delphi technique was used to survey nearly 200 paediatric consultants in two rounds with the question: "What activities or behaviours do you feel are reassuring and significantly reduce the likelihood that a febrile child has possible sepsis?" Three behaviours were reported as reassuring by over 90% of respondents: 1. Being actively energetic (e.g. running, jumping or similar)2. Being talkative, chatty, babbling or cooing (age appropriate)3. Playing4. Eating (>70%)The least reassuring behaviours were showing fear of the clinician and using an electronic device ('iPhone positive' may not be a reliable sign in kids)
The bottom line: This is the first attempt at defining wellness in febrile children. It suggests that being energetic, talkative, playing and eating are reassuring features that contribute to clinician gestalt.
Expert commentary:"This is a very interesting study, something we constantly do in Paediatric ED but something I have difficulty teaching ("Well children look well," is commonly said but is difficult to define). This study shows the importance of looking at the child's behaviour both in a cubical and in the waiting room, and of observing them over time." (Dr Emily Goodlad, Paediatric Consultant)
"I strongly agree with these findings. In kids, even tonsillitis can trigger the 'sepsis 6' protocol. As a paediatrician, seeing the child as a whole - smiling, playing, running around - is vital and helps us to decide the management."(Dr Mohsin Jafri, Paediatric Consultant)