Here's how one children's hospital is working to rapidly detect sepsis, which has new importance during flu season.
The 2017-18 flu season has hit the nation's children's hospitals hard, with pediatric physicians and nurses seeing a surge in kids coming to the emergency department (ED) with fevers and other flu-like symptoms. As of Feb. 10, the Centers for Disease Control and Prevention counted 84 pediatric deaths from influenza since the first of the year.
In most cases, patients fight the virus off on their own, using the standard prescription of rest and fluids. However, the rise in pediatric deaths associated with influenza could be linked to sepsis, introducing a new variable—and urgency—to treating children with influenza in pediatric EDs.
"Influenza, like many viruses, can cause a temporary weakening of the immune system, putting the body at higher risk of bacterial infection, in addition to other complications caused by the virus," says Jonathan A. Silverman, M.D., MPH, who specializes in emergency medicine at Children's Hospital of Richmond at VCU (CHoR). "Especially in cases of bacterial pneumonia caused by the flu, children may suffer respiratory failure or full bacterial sepsis from spread of infection, in rare cases resulting in the death of the child."
Sepsis can be challenging to detect because its early symptoms mirror that of common illnesses—fever, cold hands and feet, and difficulty breathing—and there is no definitive laboratory test for the condition. It's deemed the "silent killer" because of its ability to go undetected.
"The flu has certainly strained our resources, but sepsis screening has become part of our routine process," Silverman says. "We are all aware of the risk of missing the septic child among the sea of otherwise well children with influenza, so the process is respected."
Screening for sepsis
In January 2016, CHoR implemented mandatory sepsis screenings in the ED for all children with a fever. This approach has helped the hospital identify cases of sepsis that would otherwise go undiagnosed and cause severe illness or death.
Nurses conduct a full sepsis screening, which takes less than a minute. Abnormal vital signs, cold extremities, confusion, weak pulses, and abnormal rashes are observed as early signs of sepsis. Additionally, other compromising factors are identified, which can include diagnoses of leukemia, cerebral palsy or sickle cell disease that would put a patient at an increased risk of developing sepsis.
Next, nurses immediately notify physicians if a patient has a positive score, meaning they are at risk of having sepsis. Because there is no blood test for sepsis, physicians must quickly make the formal diagnosis and determine the method of treatment.
Patients who are suspected of having sepsis are treated immediately in what Silverman refers to as the "Golden Hour," when interventions begin as soon as sepsis is detected. IV antibiotics and fluids administered within this short window are the most effective.
In the first six months after implementing sepsis screening for children in their ED, Silverman says there were no missed cases of sepsis at CHoR. The last two years have also proved to be consistent in screening for septic children, with only a few cases of kids without positive sepsis scores developing the condition. In those cases, Silverman says the team intervened appropriately.
Implementing sepsis screenings included comprehensive online and in-person trainings for nurses, residents and physicians, a process borrowed from Seattle Children's Hospital after CHoR joined the Pediatric Septic Shock Collaborative sponsored by the American Academy of Pediatrics. Silverman says nurses experienced a new sense of empowerment that helped them advocate for their patients.
In addition to saving lives, the introduction of sepsis screenings has the ability to reduce overall hospital costs by improving patient outcomes and shortening hospital stays. In a CHA sepsis webinar presentation, a team from Phoenix Children's Hospital outlined the costs associated with sepsis screenings, and found that the facility avoided costs of about $950,000 per year.
For Silverman and the CHoR team, sepsis screenings are a positive intervention that leads to better patient outcomes. They continue to emphasize the importance of rapid screenings and treatment, while also promoting sepsis education for families to help identify early symptoms.
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