{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:10:52Z","timestamp":1755216652940,"version":"3.43.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>Sepsis screening tools in Pediatric Emergency Departments (PEDs) enable timely alerts and treatment. This study aimed to develop, implement, and evaluate a sepsis screening tool applied during triage in patients with fever or hypothermia in a PED.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>The study was conducted in 3 phases (design, implementation, and evaluation) from July 1, 2023, to July 31, 2024. The screening tool included the Pediatric Assessment Triangle (PAT), parental concern, critical appearance, vital signs, mental status, skin condition, capillary refill, and risk factors, with results classified as positive or negative. Evaluation followed an observational, prospective diagnostic test design using 3 reference standards: intention-to-treat standard, Phoenix criteria, and final diagnosis at case closure. Patients aged &gt;28 days to &lt;18 years with fever or hypothermia were included. Results were analyzed for diagnostic accuracy (sensitivity, specificity, predictive values, and likelihood ratios). Additional analyses were performed to examine the triggers of positive alerts and causes of missed alerts.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>During the evaluation period, 16,771 of 40,005 PED patients had fever or hypothermia. The tool was positive in 1.4% (240\/16,672). These patients had significantly more triage levels I and II (99.6% vs. 4.8%), higher hospitalization rates (66% vs. 5%), pediatric intensive care unit admissions (11% vs. 0.03%), and mortality (3.8% vs. 0.01%). For sepsis at case closure, the tool showed sensitivity of 0.80, specificity of 0.99, positive predictive value of 0.33, negative predictive value of 1, positive likelihood ratio of 84, and negative likelihood ratio of 0.20. Circulatory alteration in the PAT [odds ratio (OR): 2.8], abnormal capillary refill (OR: 1.9), and critical risk factors (OR: 2.1) independently increased the risk of sepsis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The sepsis screening tool evaluated demonstrated good performance in detecting sepsis in the PED. Circulatory alteration in the PAT, abnormal capillary refill, and presence of a critical risk factor were key sepsis predictors.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003399","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T08:01:12Z","timestamp":1746518472000},"page":"e58-e66","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Development, Implementation, and Evaluation of an Early Sepsis Screening Tool at Triage in a Pediatric Emergency Department in Latin America"],"prefix":"10.1097","volume":"41","author":[{"given":"Natalia","family":"Lopera M\u00fanera","sequence":"first","affiliation":[{"name":"Hospital General Pedi\u00e1trico Ni\u00f1os de Acosta \u00d1u, San Lorenzo, Paraguay\ufeff"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria E.","family":"Ch\u00e1vez","sequence":"additional","affiliation":[{"name":"Hospital General Pedi\u00e1trico Ni\u00f1os de Acosta \u00d1u, San Lorenzo, Paraguay\ufeff"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lourdes","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Hospital General Pedi\u00e1trico Ni\u00f1os de Acosta \u00d1u, San Lorenzo, Paraguay\ufeff"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura P.","family":"Morilla Sanabria","sequence":"additional","affiliation":[{"name":"Hospital General Pedi\u00e1trico Ni\u00f1os de Acosta \u00d1u, San Lorenzo, Paraguay\ufeff"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirta","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Hospital General Pedi\u00e1trico Ni\u00f1os de Acosta \u00d1u, San Lorenzo, Paraguay\ufeff"},{"name":"Universidad Cat\u00f3\ufefflica Nuestra Se\u00f1ora de la Asunci\u00f3n, Sede Asunci\u00f3\ufeffn"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viviana","family":"Pavlicich","sequence":"additional","affiliation":[{"name":"Hospital General Pedi\u00e1trico Ni\u00f1os de Acosta \u00d1u, San Lorenzo, Paraguay\ufeff"},{"name":"Universidad Privada del Pac\u00ed\ufefffico, Sede Asunci\u00f3n, Asunci\u00f3n, Paraguay"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,5,6]]},"reference":[{"key":"R1-20250804","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2213-2600(18)30063-8","article-title":"The global burden of paediatric and neonatal sepsis: a systematic review","volume":"6","author":"Fleischmann-Struzek","year":"2018","journal-title":"Lancet Respir Med"},{"key":"R2-20250804","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/S2352-4642(24)00140-8","article-title":"The burden and contemporary epidemiology of sepsis in children","volume":"8","author":"Watson","year":"2024","journal-title":"Lancet Child Adolesc Health"},{"key":"R3-20250804","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/PCC.0000000000002198","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"21","author":"Weiss","year":"2020","journal-title":"Pediatr Crit Care Med"},{"key":"R4-20250804","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1097\/CCM.0000000000002425","article-title":"American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock","volume":"45","author":"Davis","year":"2017","journal-title":"Crit Care Med"},{"key":"R5-20250804","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S2352-4642(21)00341-2","article-title":"Challenges and health-care priorities for reducing the burden of paediatric sepsis in Latin America: a call to action","volume":"6","author":"Souza","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"key":"R6-20250804","doi-asserted-by":"crossref","first-page":"e757","DOI":"10.1097\/PEC.0000000000001838","article-title":"How are clinicians treating children with sepsis in emergency departments in Latin America? 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