Pediatric SIRS, Sepsis, and Septic Shock Criteria

id

1977

full_title

Pediatric SIRS, Sepsis, and Septic Shock Criteria

short_title

Pediatric SIRS

med_description

Defines the severity of sepsis and septic shock for pediatric patients.

description

The Pediatric SIRS, Sepsis, and Septic Shock Criteria defines the severity of sepsis and septic shock for pediatric patients.

keywords

sirs, sepsis, septic shock, peds sirs, peds sepsis, peds shock, peds septic fever, peds septic shock, peds fever cause, PICU, peds ICU, ICCPS, ICCPS guidelines, ICCPS sepsis, ICCPS rule, ICCPS score, ICCPS cds, child sepsis, child septic shock, child SIRS, pediatric sirs, systemic inflammatory peds, systemic inflammatory peds

complaint

[ "Fever" ]

formula

Series of Yes/No questions.

evidence

• ICCPS derived 6 clinically and physiologically-based age groups each with distinct VS ranges and laboratory ranges: Newborn (0-7 days); Neonate (7 days-1 month); Infant (1 month-1 year); Toddler/Preschool (2-5 years); School-aged Child (6-12 years); Adolescent & Young Adult (13- <18 years).
• Higher temperature cut-off than adult SIRS criteria and requirement of either temperature or leukocyte abnormality are to increase specificity of SIRS criteria.
• Studies are ongoing to determine pediatric-specific sepsis “bundles” and treatment protocols.
• There are several pediatric-specific data supporting screening with lactate levels, and high lactate has been associated with increased risk of organ dysfunction and critical illness in ICCPS-defined SIRS. (Scott 2012)
• Temperature-corrected heart and respiratory rates may improve specificity & PPV without lowering sensitivity. (Sepanski 2014)

measurements

[]

information

• SIRS = ≥2 meets SIRS definition
• 1 of which must be abnormal temperature or leukocyte count.
• Sepsis = SIRS + Suspected infection
• Infectious etiology may be bacterial, viral, or fungal.
• Severe Sepsis = Sepsis +1 of the following:
• Cardiovascular organ dysfunction
• Acute respiratory distress syndrome (ARDS)
• Evidence of ≥2 organ dysfunction (e.g., respiratory, renal, neurologic, hematologic, or hepatic)
• Septic Shock = Severe Sepsis + Cardiovascular Dysfunction (despite adequate fluid resuscitation)
• Unlike with adults, hypotension is not required to make the diagnosis of Septic Shock.

1. Tachycardia is defined as mean HR >2 SD above normal for age not resulting from external stimulus, chronic drugs, or painful stimuli; or unexplained persistent tachycardia over a 0.5- to 4-hr duration. In children <1 yr old, bradycardia is defined as a mean HR <10th percentile for age not resulting from external vagal stimulus, B-blocker drugs, or congenital heart disease; or unexplained persistent bradycardia over a 0.5-hr duration.
2. Tachypnea is defined as mean respiratory rate >2 SD above normal for age or mechanical ventilation resulting from an acute process not caused by underlying neuromuscular disease or due to general anesthesia.
3. Not as a result of chemotherapy-induced leukopenia. Values taken from The Harriet Lane handbook.
4. Values differ slightly from PALS definition of hypotension as published by the American Heart Association.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/15636651", "text": "Goldstein B, Giroir B, Randolph A, and the Members of the International Consensus Conference on Pediatric Sepsis. International Pediatric Sepsis Consensus Conference (ICCPS): Definitions for Sepsis and Organ Dysfunction in Pediatrics. Pediatr Crit Care Med. 2005; 6(1): 2-8." } ], "Other References": [ { "href": "https://link.springer.com/article/10.1007%2Fs00134-012-2769-8", "text": "R. P. Dellinger, et. al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Medicine. February 2013; 39(2), 165-228." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/19325359", "text": "Brierley J, Carcillo J, Choong K, et al. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. 2007 Update from the American College of Critical Care Medicine. Crit Care Med. 2009; 37:666–688." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23167859", "text": "Scott HF, Donoghue AJ, Gaieski DF, Marchese RF, Mistry RD. The Utility of Early Lactate Testing in Undifferentiated Pediatric Systemic Inflammatory Response Syndrome. Academic Emergency Medicine. 2012; 19: 1276-80." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058838/", "text": "Sepanski RJ, Godambe SA, Mangum CD, Bovat CS, Zaritsky AL, Shah SH. Designing a Pediatric Severe Sepsis Screening Tool. Frontiers in Pediatrics. 2014;2:56. doi:10.3389/fped.2014.00056." } ], "Outcomes": [], "Validation": [], "Validations": [] }

pearls

• These criteria are more debated than the adult criteria. The International Consensus Conference on Pediatric Sepsis (ICCPS) convened in 2005 to create definitions, but vital sign ranges with age make it difficult to come to clear concensus.
• Lactate is not yet accepted as standard screening tool.
• Tachycardia and tachypnea are extremely common in mild pediatric illness; these are not as useful in selecting for septic patients. Therefore either a temperature or leukocyte abnormality must be present to meet pediatric SIRS criteria.
• Others abnormalities are age-specific - Vital Signs (VS), physiologic processes (e.g., urine output), and certain laboratory values.
  • However, there is no consensus on the particular ages - ICCPS experts differ from PALS ranges published by American Heart Association, which differ from many institutional guidelines.
• ICCPS-defined cut offs differ slightly from adults:
  • Temperature of >38.5C for pediatrics, >38C for adults.
  • Bradycardia included for newborns and neonates.

usecase

• Children <18 years old with ≥2 SIRS criteria should be screened for severe sepsis / septic shock.
• Fever in patients <2-3 months - a different topic of study - requires an extensive sepsis evaluation using a lower temperature threshold (i.e., ≥38C).
  • There is good agreement to do full neonatal fever workups for neonates ≤28 days. However workup and interventions for ages 1-3 months are continually changing and often institution-dependent.

reasons

Sepsis is a major cause of preventable death in children, with estimated mortality in severe sepsis ranging from 2% in previously well children to 10% in those with significant underlying medical conditions. This is lower than in adult severe sepsis, but still significant.

next_advice

next_actions

• Surviving Sepsis Campaign (2012) section on Pediatric Considerations reiterates the most recent PALS guidelines as described by Brierley and colleagues.
• Historically pediatric sepsis management has been provider-dependent. More recently some hospitals and US states are instituting, studying, and fine-tuning standardized pediatric sepsis protocols.

next_management

• Much of the current practice in pediatric sepsis screening are applied from the adult literature, and therefore not directly evidence-based.
• Similar to adults, Those with a suspected/confirmed infection with hemodynamic instability should immediately be treated for Septic Shock without waiting for laboratory confirmation.
• Similar to adults, early IV fluids and broad-spectrum antibiotics seem to be the most critical actions.
• IV fluid recommendations include repeated 20cc/kg boluses of isotonic crystalloid or colloid over 5-10 minute intervals.
• Consider consulting an ICU when severe sepsis / septic shock is identified.

Pediatric Advanced Life Support (PALS) 2011 Algorithm for Septic Shock

diseases

[ "Sepsis" ]

instructions

Note: There is still debate about how to define pediatric sepsis given varying ranges of “normal” vital signs for ages. For patients over 18, please use the Adult SIRS, Sepsis, and Septic Shock Criteria.

published

2022-04-21T20:29:05.382Z

purpose

[ "Diagnosis" ]

search_terms

[ "SIRS", "peds", "sepsis", "ICCPS", "Systemic inflammatory response syndrome" ]

seo

{ "keywords_en": "sirs, sepsis, septic shock, peds sirs, peds sepsis, peds shock, peds septic fever, peds septic shock, peds fever cause, PICU, peds ICU, ICCPS, ICCPS guidelines, ICCPS sepsis, ICCPS rule, ICCPS score, ICCPS cds, child sepsis, child septic shock, child SIRS, pediatric sirs, systemic inflammatory peds, systemic inflammatory peds", "meta_description_en": "The Pediatric SIRS, Sepsis, and Septic Shock Criteria defines the severity of sepsis and septic shock for pediatric patients." }

specialty

[ "Critical Care", "Critical Care (Neonatal)", "Critical Care (Pediatric)", "Emergency Medicine", "Infectious Disease", "Internal Medicine", "Pediatric Subspecialty", "Pediatrics" ]

departments

[ "Cardiac", "Infectious" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1096, "short_title_en": "SIRS & Sepsis Criteria", "slug": "sirs-sepsis-septic-shock-criteria" }, { "calcId": 2654, "short_title_en": "qSOFA", "slug": "qsofa-quick-sofa-score-sepsis" }, { "calcId": 10509, "short_title_en": "Phoenix Sepsis Score", "slug": "phoenix-sepsis-score" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "infectious" ]

cleaned_use

[ "Children <18 years old with ≥2 SIRS criteria should be screened for severe sepsis / septic shock.", "Fever in patients <2-3 months - a different topic of study - requires an extensive sepsis evaluation using a lower temperature threshold (i.e., ≥38C).There is good agreement to do full neonatal fever workups for neonates ≤28 days. However workup and interventions for ages 1-3 months are continually changing and often institution-dependent.", "There is good agreement to do full neonatal fever workups for neonates ≤28 days. However workup and interventions for ages 1-3 months are continually changing and often institution-dependent." ]

pub

true