Sepsis Clinical Pathway – Emergency Department, Inpatient and PICU

Yellow Zone – Sepsis Watcher
Initial Laboratory Testing Considerations for Suspected Bacterial Infection without Organ Dysfunction

Tailor laboratory studies based on clinical presentation or other disease/pathway specific recommendations.

Blood

Blood Culture	Blood Culture Sources Blood Culture Clinical Pathway, PICU/PCU
Laboratory Studies to Consider Based on Clinical Presentation	POC glucose Super gas with lactate CBC with differential Type and screen CRP Procalcitonin	BMP Magnesium Phosphorus Hepatic function panel Amylase, lipase PT/INR/PTT/fibrinogen

Urine

Urinalysis, Culture	Send urine culture based on urinalysis results or for clinical concern
Urine HCG	Perform in ED or on Admission: All females ≥ 12 years, and females < 12 years that have experienced menarche

Consider the Following Infectious Studies as Indicated Based on Patient Signs, Symptoms, History, Physical Exam

Respiratory

COVID	Given COVID-19 is now considered endemic, screening has become part of routine clinical practice.
Quad Screen (COVID/Flu/RSV PCR)	Send during winter respiratory viral season in patients with fever and lower respiratory tract symptoms
Respiratory Viral Panel	Send if signs or symptoms of respiratory infection and specific viral diagnosis will change management (e.g., Immunocompromised patients, suspected nosocomial viral infection) Includes testing for coronavirus 229E/OC43/HKU1/NL63
Respiratory Gram Stain, Culture	Send from an artificial airway only if a bacterial lower respiratory tract infection is suspected (e.g., Pneumonia on an X-ray) See Guidance for Collection of Tracheal Aspirate Cultures in the PICU/PCU
Mycoplasma PCR	Consider sending in children > 5 years in whom atypical pneumonia is suspected Pneumonia Clinical Pathway

CSF

CSF Profile, Gram Stain, Culture	Send if suspected encephalitis or meningitis Suspected Meningitis Clinical Pathway If suspected encephalitis, consider also sending save our specimen tube
HSV PCR	Send if suspected encephalitis or meningitis Suspected Meningitis Clinical Pathway

Stool

GI Bacterial Panel/stool Culture	This assay detects bacterial causes of community acquired diarrhea and should only be sent on patients who are hospitalized for < 48 hours

Skin

Wound Culture	As indicated if evidence of skin or soft tissue infections, cellulitis, abscess, etc.

Consider Inflammatory Conditions that May Manifest with Fever and Shock

Kawasaki Disease	See Kawasaki Disease Clinical Pathway for recommendations on laboratory testing

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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.