title: Recognition and Management of Sepsis in Children: Practice Patterns in the Emergency Department.
abstract: BACKGROUND
  Pediatric sepsis remains a leading cause of morbidity and mortality. Understanding current practice patterns and challenges is essential to inform future research and education strategies.
  
  
  OBJECTIVE
  Our aim was to describe the practice patterns of pediatric emergency physicians (PEPs) in the recognition and management of sepsis in children and to identify perceived priorities for future research and education.
  
  
  METHODS
  We conducted a cross-sectional, internet-based survey of members of the American Academy of Pediatrics, Section on Emergency Medicine and Pediatric Emergency Research Canada. The survey was internally derived, externally validated, and distributed using a modified Dillman methodology. Rank scores (RS) were calculated for responses using Likert-assigned frequency values.
  
  
  RESULTS
  Tachycardia, mental-status changes, and abnormal temperature (RS = 83.7, 80.6, and 79.6) were the highest ranked clinical measures for diagnosing sepsis; white blood cell count, lactate, and band count (RS = 73.5, 70.9, and 69.1) were the highest ranked laboratory investigations. The resuscitation fluid of choice (85.5%) was normal saline. Dopamine was the first-line vasoactive medication (VAM) for cold (57.1%) and warm (42.2%) shock with epinephrine (18.5%) and norepinephrine (25.1%) as second-line VAMs (cold and warm, respectively). Steroid administration increased with complexity of presentation (all-comers 3.8%, VAM-resistant shock 54.5%, chronic steroid users 72.0%). Local ED-specific clinical pathways, national emergency department (ED)-specific guidelines, and identification of clinical biomarkers were described as future priorities.
  
  
  CONCLUSIONS
  While practice variability exists among clinicians, PEPs continue to rely heavily on clinical metrics for recognizing sepsis. Improved recognition through clinical biomarkers and standardization of care were perceived as priorities. Our results provide a strong framework to guide future research and education strategies in pediatric sepsis.
authors.affiliation: Department of Pediatrics, Alberta Children's Hospital/University of Calgary, Calgary, Alberta, Canada.
authors.forename: Graham C
authors.initials: GC
authors.lastname: Thompson
authors.affiliation: Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012151:Resuscitation / Q000706:statistics & numerical data; D018805:Sepsis / Q000175:diagnosis* / Q000628:therapy*; D014481:United States; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents
keywords: child; diagnosis; emergency department; management; sepsis