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