Impact of parental and healthcare professional concern on the diagnosis of pediatric sepsis: a diagnostic accuracy study

Zoe Sever; Luregn J Schlapbach; Patricia Gilholm; Melanie Jessup; Natalie Phillips; Shane George; Kristen Gibbons; Amanda Harley

doi:10.3389/fped.2023.1140121

Impact of parental and healthcare professional concern on the diagnosis of pediatric sepsis: a diagnostic accuracy study

Front Pediatr. 2023 Apr 17:11:1140121. doi: 10.3389/fped.2023.1140121. eCollection 2023.

Authors

Zoe Sever¹, Luregn J Schlapbach^{2

3

4}, Patricia Gilholm², Melanie Jessup¹, Natalie Phillips^{2

5}, Shane George^{2

6

7}, Kristen Gibbons², Amanda Harley^{1

2

6

8}

Affiliations

¹ School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
² Child Health Research Centre, University of Queensland, South Brisbane, QLD, Australia.
³ Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
⁴ Department of Intensive Care and Neonatology, Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland.
⁵ Emergency Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
⁶ Departments of Emergency Medicine and Children's Critical Care Service, Gold Coast University Hospital, Southport, QLD, Australia.
⁷ Faculty of Health, School of Medicine, and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
⁸ Critical Care Nursing Management Team, Queensland Children's Hospital, Brisbane, QLD, Australia.

Abstract

Objective: The Surviving Sepsis Campaign recommends systematic screening for sepsis. Although many sepsis screening tools include parent or healthcare professional concern, there remains a lack of evidence to support this practice. We aimed to test the diagnostic accuracy of parent and healthcare professional concern in relation to illness severity, to diagnose sepsis in children.

Design: This prospective multicenter study measured the level of concern for illness severity as perceived by the parent, treating nurse and doctor using a cross-sectional survey. The primary outcome was sepsis, defined as a pSOFA score >0. The unadjusted area under receiver-operating characteristic curves (AUC) and adjusted Odds Ratios (aOR) were calculated.

Setting: Two specialised pediatric Emergency Departments in Queensland.

Patients: Children aged 30 days to 18 years old that were evaluated for sepsis.

Intervention: None.

Main results: 492 children were included in the study, of which 118 (23.9%) had sepsis. Parent concern was not associated with sepsis (AUC 0.53, 95% CI: 0.46-0.61, aOR: 1.18; 0.89-1.58) but was for PICU admission (OR: 1.88, 95% CI: 1.17-3.19) and bacterial infection (aOR: 1.47, 95% CI: 1.14-1.92). Healthcare professional concern was associated with sepsis in both unadjusted and adjusted models (nurses: AUC 0.57, 95% CI-0.50, 0.63, aOR: 1.29, 95% CI: 1.02-1.63; doctors: AUC 0.63, 95% CI: 0.55, 0.70, aOR: 1.61, 95% CI: 1.14-2.19).

Conclusions: While our study does not support the broad use of parent or healthcare professional concern in isolation as a pediatric sepsis screening tool, measures of concern may be valuable as an adjunct in combination with other clinical data to support sepsis recognition.

Clinical trial registration: ACTRN12620001340921.

Keywords: concern; diagnosis; doctor; nurse; parent; sepsis.

Grants and funding

This study was supported by grants from the Emergency Medicine Foundation Queensland, the Gold Coast Hospital Foundation, and the Australian Government's Medical Research Future Fund (MRFF) Rapid Applied Research Translation program grant awarded to Brisbane Diamantina Health Partners.