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 |
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Heart Rate Abnormality | See table below |
PLUS ONE OF THE FOLLOWING:
Mental Status Abnormality |
Anxiety, restlessness, agitation, irritability, inappropriate crying |
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Perfusion Abnormality | Cool extremities, capillary refill > 3 seconds, diminished pulses, mottling or Flushed, warm extremities, bounding pulses, flash capillary refill |
High Risk Conditions |
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Age | Tachycardia ( > 95th percentile ) |
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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
Please see: ICU Pathway for the Evaluation/Treatment of Infants > 28 Days and Children with Severe Sepsis/Septic Shock