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    Patent Pending

    Pediatric SIRS, Sepsis, and Septic Shock Criteria

    Defines the severity of sepsis and septic shock for pediatric patients.
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    INSTRUCTIONS

    Note: There is still debate about how to define pediatric sepsis given varying ranges of “normal” vital signs for ages. For patients over 18, please use the Adult SIRS, Sepsis, and Septic Shock Criteria.
    When to Use
    Pearls/Pitfalls
    Why Use
    • Children <18 years old with ≥2 SIRS criteria should be screened for severe sepsis / septic shock.
    • Fever in patients <2-3 months - a different topic of study - requires an extensive sepsis evaluation using a lower temperature threshold (i.e., ≥38C).
      • There is good agreement to do full neonatal fever workups for neonates ≤28 days. However workup and interventions for ages 1-3 months are continually changing and often institution-dependent.
    • These criteria are more debated than the adult criteria. The International Consensus Conference on Pediatric Sepsis (ICCPS) convened in 2005 to create definitions, but vital sign ranges with age make it difficult to come to clear concensus.
    • Lactate is not yet accepted as standard screening tool.
    • Tachycardia and tachypnea are extremely common in mild pediatric illness; these are not as useful in selecting for septic patients. Therefore either a temperature or leukocyte abnormality must be present to meet pediatric SIRS criteria.
    • Others abnormalities are age-specific - Vital Signs (VS), physiologic processes (e.g., urine output), and certain laboratory values.
      • However, there is no consensus on the particular ages - ICCPS experts differ from PALS ranges published by American Heart Association, which differ from many institutional guidelines.
    • ICCPS-defined cut offs differ slightly from adults:
      • Temperature of >38.5C for pediatrics, >38C for adults.
      • Bradycardia included for newborns and neonates.

    Sepsis is a major cause of preventable death in children, with estimated mortality in severe sepsis ranging from 2% in previously well children to 10% in those with significant underlying medical conditions. This is lower than in adult severe sepsis, but still significant.

    SIRS Criteria (≥ 2 meets SIRS definition, 1 of which must be abnormal temperature or leukocyte count)
    List of Age-Dependent Vital Sign Ranges Available in About Section
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    Sepsis Criteria (SIRS + Source of Infection)
    No
    Yes
    Severe Sepsis Criteria (Sepsis + ≥ 1 following Dysfunction Criteria)
    Organ Dysfunction Criteria »
    No
    Yes
    Septic Shock Criteria (Sepsis + Cardiovascular Dysfunction)
    Organ Dysfunction Criteria »
    No
    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    • Much of the current practice in pediatric sepsis screening are applied from the adult literature, and therefore not directly evidence-based.
    • Similar to adults, Those with a suspected/confirmed infection with hemodynamic instability should immediately be treated for Septic Shock without waiting for laboratory confirmation.
    • Similar to adults, early IV fluids and broad-spectrum antibiotics seem to be the most critical actions.
    • IV fluid recommendations include repeated 20cc/kg boluses of isotonic crystalloid or colloid over 5-10 minute intervals.
    • Consider consulting an ICU when severe sepsis / septic shock is identified.

    Pediatric Advanced Life Support (PALS) 2011 Algorithm for Septic Shock