{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:13:22Z","timestamp":1772648002404,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pediatric shock is a final common pathway of cardiovascular failure across diverse emergencies, yet data from mixed emergency cohorts outside intensive care units remain limited. This study aimed to describe the distribution, etiologic subtypes, and clinical correlates of shock in children presenting within a diagnosis-based emergency cohort. Methods: A retrospective single-centre study was conducted in children aged 0\u201316 years presenting with selected acute pediatric emergencies, among whom cases with and without shock were compared. Shock was defined using documented diagnoses and compatible hemodynamic features, and multiple etiologic types of shock were analyzed, including hypovolemic, septic, cardiogenic, and anaphylactic shock. Demographic and diagnostic variables\u2014age, length of stay, organ support, age strata, and selected comorbidities\u2014and baseline clinical features were compared between children with and without shock using non-parametric and \u03c72\/Fisher\u2019s exact tests. Results: Within the prespecified diagnosis-based analytic cohort, 36\/128 children (28.1%) met the study criteria for shock and occurred across all prespecified acute pediatric emergency groups, with the highest proportional burden in heart failure and meningitis; this proportion should not be interpreted as an emergency-department prevalence estimate. Children with shock were younger, with clustering in infants &lt; 1 year and those aged 5\u20139 years, and tended to stay longer in hospital. Pre-existing cardiac disease, severe dehydration, and altered mental status\/coma were more frequent among children with shock. Septic and cardiogenic shock required the most intensive organ support. Conclusions: In this pediatric emergency cohort, shock emerged as a clinically relevant and etiologically heterogeneous complication across diverse acute presentations, with a distinct age-related vulnerability pattern and consistent associations with readily identifiable bedside clinical features. Simple bedside information\u2014particularly cardiac comorbidity, dehydration, and altered consciousness\u2014may assist the early recognition of children with evolving circulatory failure and support closer monitoring and timely escalation of care. By focusing on a mixed emergency population outside the intensive care unit, this study provides a real-world clinical perspective that may help refine early bedside assessment and improve vigilance for shock in pediatric emergency departments.<\/jats:p>","DOI":"10.3390\/children13030366","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:01:07Z","timestamp":1772636467000},"page":"366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Shock Across Acute Emergencies: Age Patterns, Etiologic Subtypes, and Bedside Clinical Indicators in a Single-Centre Cohort"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6414-832X","authenticated-orcid":false,"given":"Cristina Elena","family":"Singer","sequence":"first","affiliation":[{"name":"Department of Mother and Baby, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ion Dorin","family":"Pluta","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Behavioral Sciences, Constantin Br\u00e2ncu\u0219i University of T\u00e2rgu Jiu, 210185 T\u00e2rgu Jiu, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7801-5646","authenticated-orcid":false,"given":"\u0218tef\u0103ni\u021ba Bianca","family":"Vintilescu","sequence":"additional","affiliation":[{"name":"Department of Mother and Baby, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Popescu Elena","family":"Madalina","sequence":"additional","affiliation":[{"name":"Department of Mother and Baby, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George Alin","family":"Stoica","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renata-Maria","family":"Varut","sequence":"additional","affiliation":[{"name":"Research Methodology Department, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pirscoveanu Denisa Floriana","family":"Vasilica","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-7583","authenticated-orcid":false,"given":"Virginia","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuica Valentina","family":"Geanina","sequence":"additional","affiliation":[{"name":"Clinical Pharmacist, V\u00e2lcea County Emergency Hospital, 240284 R\u00e2mnicu V\u00e2lcea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denisa","family":"Preoteasa","sequence":"additional","affiliation":[{"name":"Clinical Pharmacist, V\u00e2lcea County Emergency Hospital, 240284 R\u00e2mnicu V\u00e2lcea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9356-6593","authenticated-orcid":false,"given":"Mocanu","family":"Andreea Gabriela","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Sirbulet","sequence":"additional","affiliation":[{"name":"Discipline of Anatomy, Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/S2352-4642(23)00103-7","article-title":"Haemodynamic support for paediatric septic shock: A global perspective","volume":"7","author":"Ranjit","year":"2023","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_3","first-page":"757","article-title":"The Nomenclature, Definition and Distinction of Types of Shock","volume":"115","author":"Standl","year":"2018","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1097\/PEC.0b013e3181ef04b9","article-title":"Clinical spectrum of shock in the pediatric emergency department","volume":"26","author":"Fisher","year":"2010","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Fleming, S., Gill, P., Jones, C., Taylor, J.A., Van den Bruel, A., Heneghan, C., Roberts, N., and Thompson, M. (2015). The diagnostic value of capillary refill time for detecting serious illness in children: A systematic review and meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138155"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1001\/jamapediatrics.2016.3681","article-title":"Association between early lactate levels and 30-day mortality in clinically suspected sepsis in children","volume":"171","author":"Scott","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yoon, S.H., Shin, S.-J., Kim, H., and Roh, Y.H. (2024). Shock index and shock index, pediatric age-adjusted as predictors of mortality in pediatric trauma patients: A systematic review and meta-analysis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0307367"},{"key":"ref_8","first-page":"469","article-title":"Suboptimal care in the initial management of children who died from severe bacterial infection: A population-based confidential inquiry","volume":"11","author":"Launay","year":"2010","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2483","DOI":"10.1056\/NEJMoa1101549","article-title":"Mortality after fluid bolus in African children with severe infection (FEAST trial)","volume":"364","author":"Maitland","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.annemergmed.2007.06.482","article-title":"Rapid fluid resuscitation in pediatrics: Testing the American College of Critical Care Medicine guideline","volume":"50","author":"Stoner","year":"2007","journal-title":"Ann. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1164\/rccm.201412-2323OC","article-title":"Global Epidemiology of Pediatric Severe Sepsis: The Sepsis PRevalence, Outcomes, and Therapies Study","volume":"191","author":"Weiss","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","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":"Goldfarb","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Watson, R.S., Carrol, E.D., Carter, M.J., Kissoon, N., Ranjit, S., and Schlapbach, L.J. (Lancet Child Adolesc. Health, 2024). The Burden and Contemporary Epidemiology of Sepsis in Children, Lancet Child Adolesc. Health, online ahead of print.","DOI":"10.1016\/S2352-4642(24)00140-8"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1055\/s-0038-1676634","article-title":"Epidemiology of Pediatric Septic Shock","volume":"8","author":"Machado","year":"2019","journal-title":"J. Pediatr. Intensive Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"829119","DOI":"10.3389\/fped.2022.829119","article-title":"Pediatric Sepsis Research: Where Are We and Where Are We Going?","volume":"10","author":"Silami","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_16","unstructured":"World Health Organization (WHO) (2025, November 22). Diarrhoeal Disease. WHO Fact Sheet. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diarrhoeal-disease."},{"key":"ref_17","unstructured":"Daley, S.F., and Avva, U. (2025, November 22). Pediatric Dehydration, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK436022\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"ofae619","DOI":"10.1093\/ofid\/ofae619","article-title":"Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries","volume":"11","author":"Jones","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1002\/emp2.12173","article-title":"Updates on Pediatric Sepsis","volume":"1","author":"Cruz","year":"2020","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1161\/CIRCRESAHA.116.308996","article-title":"Heart Failure in Pediatric Patients with Congenital Heart Disease","volume":"120","author":"Hinton","year":"2017","journal-title":"Circ. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13613-016-0111-2","article-title":"Experts\u2019 Recommendations for the Management of Cardiogenic Shock in Children","volume":"6","author":"Brissaud","year":"2016","journal-title":"Ann. Intensive Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jacc.2023.11.019","article-title":"Clinical Presentation, Classification, and Outcomes of Cardiogenic Shock in Children","volume":"83","author":"Puri","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"252","DOI":"10.4103\/2321-4848.171917","article-title":"Pediatric cardiogenic shock: Current perspectives","volume":"3","author":"Kar","year":"2015","journal-title":"Arch. Med. Health Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1055\/s-0037-1603894","article-title":"Pediatric Sepsis: Clinical Markers","volume":"7","author":"Szima","year":"2017","journal-title":"J. Child Sci."},{"key":"ref_25","unstructured":"Children\u2019s Health Queensland Hospital and Health Service (2025, November 22). Sepsis: Recognition and Emergency Management in Children\u2014Sepsis Pathway. Queensland Paediatric Clinical Guidelines, Available online: https:\/\/www.childrens.health.qld.gov.au\/health-professionals\/clinical-guidelines\/sepsis."},{"key":"ref_26","unstructured":"National Institute for Health and Care Excellence (NICE) (2025, November 22). Sepsis: Recognition, Diagnosis and Early Management. NICE Guideline NG51, 2016 (Updated 2024). Available online: https:\/\/www.nice.org.uk\/guidance\/ng51."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00134-019-05878-6","article-title":"Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children","volume":"46","author":"Weiss","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s13312-020-1897-4","article-title":"International Guidelines 2020 for the Management of Septic Shock in Children","volume":"57","author":"Sahoo","year":"2020","journal-title":"Indian Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/S2352-4642(24)00142-1","article-title":"Quality Improvement Programmes in Paediatric Sepsis from a Global Health Perspective","volume":"8","author":"Paul","year":"2024","journal-title":"Lancet Child Adolesc. Health"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/366\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:30:44Z","timestamp":1772638244000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/366"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030366"],"URL":"https:\/\/doi.org\/10.3390\/children13030366","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]}}}