Blood Culture in Patients with Fever (Non-Oncology/Non-Neutropenic) Clinical Pathway — PICU

Identifying Children at Risk for Severe Sepsis/Septic Shock

Use clinical suspicion to identify patients at risk for severe sepsis or septic shock. Patients with severe sepsis/septic shock have an infection which triggers an exaggerated immune response that causes inadequate tissue perfusion leading to organ failure. Hypotension is a late finding. Early recognition and goal directed therapy improves patient outcomes.

Use the following criteria to identify children with history, symptoms suggestive of infection and inadequate tissue perfusion:

Temperature Abnormality	Fever > 38.5°C or < 36°C
Heart Rate Abnormality	See table below

PLUS ONE OF THE FOLLOWING:

Mental Status Abnormality	Anxiety, restlessness, agitation, irritability, inappropriate crying Drowsiness, confusion, lethargy, obtundation
Perfusion Abnormality	Cool extremities, capillary refill > 3 seconds, diminished pulses, mottling or Flushed, warm extremities, bounding pulses, flash capillary refill
High Risk Conditions	< 56 days of age Central line presence BMT or solid organ transplants Malignancy Immune compromised Asplenia, Sickle Cell Disease Immunosuppressive therapy Static encephalopathy Petechial, purpuric rash Erythroderma

Age	Tachycardia ( > 95th percentile )
1 mo to 1 yr	> 180
> 2 - 5 yrs	> 140
> 6 - 12 yrs	> 130
> 13 - 18 yrs	> 120

Remember, heart rate is affected by pain, anxiety, medications and hydration status.
Goldstein B. Pediatr Crit Care Med, 2005;6

Sepsis EPIC Triage Alert

Please see: ICU Pathway for the Evaluation/Treatment of Infants > 28 Days and Children with Severe Sepsis/Septic Shock

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.