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Bottom Line Recommendations English (8) French (6) All (13)

Sepsis Algorithm

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TREKK Sepsis PedsPac

This point of care algorithm is to guide initial management of pediatric sepsis in the Emergency Department. This algorithm is intended for use on patients > 28 days of age. Published online: July 2018, Version 2.0.

Bottom Line Recommendations: Sepsis

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Thompson G, Jabbour M and TREKK Network

Bottom line recommendations for the treatment and management pediatric sepsis. Published online: September 2018.

Sepsis Triage Poster

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TREKK Sepsis PedsPac

This screening tool is to facilitate early identification of suspected pediatric sepsis in the ED. Includes key indicators of sepsis and high-risk medical conditions. This screening tool is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Sepsis Pocket Card

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TREKK Sepsis PedsPac

This pocket card contains tips to recognize early shock, indications of poor perfusion, and management considerations for patients with suspected sepsis. Reverse side of pocket card includes pediatric definition of hypotension. This pocket card is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Sepsis Pre-Printed Order Set

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TREKK Sepsis PedsPac

This pre-printed order (PPO) set is for management of severe sepsis in the ED. PPO document is adaptable to your hospitals form policy. This PPO is intended for use on patients > 28 days of age. Published online: April 2017.

Sepsis References and Development Team

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TREKK Sepsis PedsPac

This document outlines the references used and team involved in the development of the sepsis PedsPac. Published online: April 2017.

Bottom Line: Paediatric Sepsis 6 (2015)

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National Health Service

Sepsis practice guideline from National Health Service. Published: 2013.

Bottom Line: Recommendations: Special considerations in pediatrics (2013)

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Surviving Sepsis Campaign

Special consideration in pediatrics from the Surviving Sepsis Campaign. Published: 2013.

Recommandations de Base: Choc septique

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Thompson G, Jabbour M and TREKK Network

Bottom line recommendations for the treatment and management pediatric sepsis - en francais. Published online: October 2018.

Algorithme Pediatrique pour Choc Septique Severe

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PedsPac de TREKK sur le Choc Septique

This point of care algorithm is to guide initial management of pediatric sepsis in the Emergency Department. This algorithm is intended for use on patients > 28 days of age. Published online: September 2018, Version 2.1.

Scanner de Triage Choc Septique

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PedsPac de TREKK sur le Choc Septique

This screening tool is to facilitate early identification of suspected pediatric sepsis in the ED. Includes key indicators of sepsis and high-risk medical conditions. This screening tool is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Carte de Poche de Choc Septique

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PedsPac de TREKK sur le Choc Septique

This pocket card contains tips to recognize early shock, indications of poor perfusion, and management considerations for patients with suspected sepsis. Reverse side of pocket card includes pediatric definition of hypotension. This pocket card is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Feuille d'Ordonnance Medicale pour Choc Septique Severe

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PedsPac de TREKK sur le Choc Septique

This pre-printed order (PPO) set is for management of severe sepsis in the ED. PPO document is adaptable to your hospitals form policy. This PPO is intended for use on patients > 28 days of age. Published online: April 2017, Version 1.0.

Sepsis References and Development Team

Download

TREKK Sepsis PedsPac

This document outlines the references used and team involved in the development of the sepsis PedsPac. Published online: April 2017.

Sepsis Algorithm

Download

TREKK Sepsis PedsPac

This point of care algorithm is to guide initial management of pediatric sepsis in the Emergency Department. This algorithm is intended for use on patients > 28 days of age. Published online: July 2018, Version 2.0.

Bottom Line Recommendations: Sepsis

Download

Thompson G, Jabbour M and TREKK Network

Bottom line recommendations for the treatment and management pediatric sepsis. Published online: September 2018.

Recommandations de Base: Choc septique

Download

Thompson G, Jabbour M and TREKK Network

Bottom line recommendations for the treatment and management pediatric sepsis - en francais. Published online: October 2018.

Sepsis Triage Poster

Download

TREKK Sepsis PedsPac

This screening tool is to facilitate early identification of suspected pediatric sepsis in the ED. Includes key indicators of sepsis and high-risk medical conditions. This screening tool is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Sepsis Pocket Card

Download

TREKK Sepsis PedsPac

This pocket card contains tips to recognize early shock, indications of poor perfusion, and management considerations for patients with suspected sepsis. Reverse side of pocket card includes pediatric definition of hypotension. This pocket card is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Sepsis Pre-Printed Order Set

Download

TREKK Sepsis PedsPac

This pre-printed order (PPO) set is for management of severe sepsis in the ED. PPO document is adaptable to your hospitals form policy. This PPO is intended for use on patients > 28 days of age. Published online: April 2017.

Algorithme Pediatrique pour Choc Septique Severe

Download

PedsPac de TREKK sur le Choc Septique

This point of care algorithm is to guide initial management of pediatric sepsis in the Emergency Department. This algorithm is intended for use on patients > 28 days of age. Published online: September 2018, Version 2.1.

Scanner de Triage Choc Septique

Download

PedsPac de TREKK sur le Choc Septique

This screening tool is to facilitate early identification of suspected pediatric sepsis in the ED. Includes key indicators of sepsis and high-risk medical conditions. This screening tool is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Carte de Poche de Choc Septique

Download

PedsPac de TREKK sur le Choc Septique

This pocket card contains tips to recognize early shock, indications of poor perfusion, and management considerations for patients with suspected sepsis. Reverse side of pocket card includes pediatric definition of hypotension. This pocket card is intended for use on patients > 28 days of age. Published online: June 2017, Version 1.0.

Feuille d'Ordonnance Medicale pour Choc Septique Severe

Download

PedsPac de TREKK sur le Choc Septique

This pre-printed order (PPO) set is for management of severe sepsis in the ED. PPO document is adaptable to your hospitals form policy. This PPO is intended for use on patients > 28 days of age. Published online: April 2017, Version 1.0.

Sepsis References and Development Team

Download

TREKK Sepsis PedsPac

This document outlines the references used and team involved in the development of the sepsis PedsPac. Published online: April 2017.

Bottom Line: Paediatric Sepsis 6 (2015)

Visit

National Health Service

Sepsis practice guideline from National Health Service. Published: 2013.

Bottom Line: Recommendations: Special considerations in pediatrics (2013)

Visit

Surviving Sepsis Campaign

Special consideration in pediatrics from the Surviving Sepsis Campaign. Published: 2013.

Clinical guidelines English (6) French All (6)

Clinical Practice Guideline: Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age (2014)

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Le Saux NCPS

Objective: This position statement outlines the rationale for current recommended empirical therapy using a third-generation cephalosporin and vancomycin for suspected bacterial meningitis. It also provides new recommendations for the use of adjuvant corticosteroids in this setting. Once antibiotic susceptibilities of the pathogen are known, antimicrobials should be reviewed and modified accordingly. Recommendations for treatment duration as well as audiology testing are included. The present statement replaces a previous Canadian Paediatric Society position statement on bacterial meningitis published in 2007 and revised in 2008. Published: 2014.

Clinical Practice Guideline: Pediatric Severe Sepsis (2011)

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Bc Children's Hospital

BC Children's Hospital Clinical Practice Guideline. Published: 2011.

Clinical Practice Guideline: Patient screening for sepsis (2011)

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Bc Children's Hospital

BC Children's Hospital patient screening tool for sepsis. Published: 2011.

Clinical Practice Guideline: Updated American College of Critical Care Medicine--pediatric advanced life support guidelines for management of pediatric and neonatal septic shock: relevance to the emergency care clinician (2010)

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Kissoon NO, R. A.; Carcillo, J. A.

Objective: Shock is a major preventable cause of morbidity and mortality in children referred to emergency care. The recently updated American College of Critical Care Medicine guidelines for the management of newborns and children with septic shock emphasize the role of emergency care in improving survival and functional outcomes. Implementation of these guidelines of stepwise use of fluids, antibiotics, and, if necessary, inotropes within the first hour of admission to the emergency department can reduce mortality and neurological morbidity risks 2-fold. Published: 2010.

Clinical Practice Guideline: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine (2009)

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Brierley JC, J. A.; Choong, K.; Cornell, T.; Decaen, A.; Deymann, A.; Doctor,...

Objective: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. Published: 2009.

Clinical Practice Guideline: Management of the infant at increased risk for sepsis (2007)

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Canadian Paediatric Society

Canadian Pediatric Society position statement on management of infants at risk for sepsis. Published: 2007.

Clinical Practice Guideline: Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age (2014)

Visit

Le Saux NCPS

Objective: This position statement outlines the rationale for current recommended empirical therapy using a third-generation cephalosporin and vancomycin for suspected bacterial meningitis. It also provides new recommendations for the use of adjuvant corticosteroids in this setting. Once antibiotic susceptibilities of the pathogen are known, antimicrobials should be reviewed and modified accordingly. Recommendations for treatment duration as well as audiology testing are included. The present statement replaces a previous Canadian Paediatric Society position statement on bacterial meningitis published in 2007 and revised in 2008. Published: 2014.

Clinical Practice Guideline: Pediatric Severe Sepsis (2011)

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Bc Children's Hospital

BC Children's Hospital Clinical Practice Guideline. Published: 2011.

Clinical Practice Guideline: Patient screening for sepsis (2011)

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Bc Children's Hospital

BC Children's Hospital patient screening tool for sepsis. Published: 2011.

Clinical Practice Guideline: Updated American College of Critical Care Medicine--pediatric advanced life support guidelines for management of pediatric and neonatal septic shock: relevance to the emergency care clinician (2010)

Visit

Kissoon NO, R. A.; Carcillo, J. A.

Objective: Shock is a major preventable cause of morbidity and mortality in children referred to emergency care. The recently updated American College of Critical Care Medicine guidelines for the management of newborns and children with septic shock emphasize the role of emergency care in improving survival and functional outcomes. Implementation of these guidelines of stepwise use of fluids, antibiotics, and, if necessary, inotropes within the first hour of admission to the emergency department can reduce mortality and neurological morbidity risks 2-fold. Published: 2010.

Clinical Practice Guideline: Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine (2009)

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Brierley JC, J. A.; Choong, K.; Cornell, T.; Decaen, A.; Deymann, A.; Doctor,...

Objective: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. Published: 2009.

Clinical Practice Guideline: Management of the infant at increased risk for sepsis (2007)

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Canadian Paediatric Society

Canadian Pediatric Society position statement on management of infants at risk for sepsis. Published: 2007.

Summaries of systematic reviews English (2) French All (2)

Cochrane Summary: Intravenous immunoglobulins for treating patients with severe sepsis and septic shock (2013)

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Alejandria Marissa MLMA, D.; Dans Leonila, F.; Mantaring, I. I. I. Jacinto Blas

Objective: For this updated Cochrane review, we searched the medical literature databases to January 2012. We included 43 randomized controlled trials (RCTs); 25 were RCTs of polyclonal intravenous immunoglobulins (IVIGs) with 17 in adults (1958 participants) and eight in newborn infants (3831 participants) including a large polyclonal IVIG trial on infants with sepsis that was published in 2011. The remaining 18 trials (a total of 13,413 participants) were of monoclonal antibodies. Published: 2013.

Cochrane Summary: Human recombinant activated protein C for severe sepsis and septic shock in adult and paediatric patients (2012)

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Mart-Carvajal Arturo JS, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona...

Objective: In this updated Cochrane review we searched the databases until June 2012. We included six randomized clinical trials which involved 6781 people (6307 adult and 474 paediatric participants) with either a high or low risk of death. All trials had high risk of bias and were sponsored by the pharmaceutical industry (Eli Lilly). moreover, there is an increased risk of bleeding associated with its use. Published: 2012.

Cochrane Summary: Intravenous immunoglobulins for treating patients with severe sepsis and septic shock (2013)

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Alejandria Marissa MLMA, D.; Dans Leonila, F.; Mantaring, I. I. I. Jacinto Blas

Objective: For this updated Cochrane review, we searched the medical literature databases to January 2012. We included 43 randomized controlled trials (RCTs); 25 were RCTs of polyclonal intravenous immunoglobulins (IVIGs) with 17 in adults (1958 participants) and eight in newborn infants (3831 participants) including a large polyclonal IVIG trial on infants with sepsis that was published in 2011. The remaining 18 trials (a total of 13,413 participants) were of monoclonal antibodies. Published: 2013.

Cochrane Summary: Human recombinant activated protein C for severe sepsis and septic shock in adult and paediatric patients (2012)

Visit

Mart-Carvajal Arturo JS, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona...

Objective: In this updated Cochrane review we searched the databases until June 2012. We included six randomized clinical trials which involved 6781 people (6307 adult and 474 paediatric participants) with either a high or low risk of death. All trials had high risk of bias and were sponsored by the pharmaceutical industry (Eli Lilly). moreover, there is an increased risk of bleeding associated with its use. Published: 2012.

Systematic reviews English (5) French All (5)

Cochrane Systematic Review: Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock (2013)

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Alejandria Marissa MLMA, D.; Dans Leonila, F.; Mantaring, I. I. I. Jacinto Blas

Objectives: To estimate the effects of IVIG as adjunctive therapy in patients with bacterial sepsis or septic shock on mortality, bacteriological failure rates, and duration of stay in hospital. Published: 2013.

Systematic Review: Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis (2013)

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Wacker CP, A.; Brunkhorst, F. M.; Schlattmann, P.

Background: Procalcitonin is a promising marker for identification of bacterial infections. We assessed the accuracy and clinical value of procalcitonin for diagnosis of sepsis in critically ill patients. Published: 2013.

Systematic Review: Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis (20

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Yo CHH, P. S.; Lee, S. H.; Wu, J. Y.; Chang, S. S.; Tasi, K. C.; Lee, C. C.

Objective: We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source. Published: 2012.

Cochrane Systematic Review: Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients (2012)

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Mart-Carvajal Arturo JS, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona...

Background: Sepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been introduced to reduce the high risk of death associated with severe sepsis or septic shock. This systematic review is an update of a Cochrane review originally published in 2007.Objectives: We assessed the benefits and harms of APC for patients with severe sepsis or septic shock. Published: 2012.

Systematic Review: Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature (2008)

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Rivers EPC, V.; Whitmill, M.

Objective: Aggressive approaches to acute diseases such as acute myocardial infarction, trauma, and stroke have improved outcomes. Early goal-directed therapy for severe sepsis and septic shock represents a similar approach. An analysis of the literature assessing external validity and generalizability of this intervention is lacking. Published: 2008.

Cochrane Systematic Review: Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock (2013)

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Alejandria Marissa MLMA, D.; Dans Leonila, F.; Mantaring, I. I. I. Jacinto Blas

Objectives: To estimate the effects of IVIG as adjunctive therapy in patients with bacterial sepsis or septic shock on mortality, bacteriological failure rates, and duration of stay in hospital. Published: 2013.

Systematic Review: Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis (2013)

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Wacker CP, A.; Brunkhorst, F. M.; Schlattmann, P.

Background: Procalcitonin is a promising marker for identification of bacterial infections. We assessed the accuracy and clinical value of procalcitonin for diagnosis of sepsis in critically ill patients. Published: 2013.

Systematic Review: Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis (20

Visit

Yo CHH, P. S.; Lee, S. H.; Wu, J. Y.; Chang, S. S.; Tasi, K. C.; Lee, C. C.

Objective: We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source. Published: 2012.

Cochrane Systematic Review: Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients (2012)

Visit

Mart-Carvajal Arturo JS, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona...

Background: Sepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been introduced to reduce the high risk of death associated with severe sepsis or septic shock. This systematic review is an update of a Cochrane review originally published in 2007.Objectives: We assessed the benefits and harms of APC for patients with severe sepsis or septic shock. Published: 2012.

Systematic Review: Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature (2008)

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Rivers EPC, V.; Whitmill, M.

Objective: Aggressive approaches to acute diseases such as acute myocardial infarction, trauma, and stroke have improved outcomes. Early goal-directed therapy for severe sepsis and septic shock represents a similar approach. An analysis of the literature assessing external validity and generalizability of this intervention is lacking. Published: 2008.

Key studies English (22) French All (22)

Key Study: Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection (2013)

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Reed LC, J.; Cummings, A.; Markwell, S.; Wall, J.; Duong, M.

Objective: No single reliable sepsis biomarker exists for risk stratification and prognostication in pediatric patients presenting to the emergency department (ED). Serum lactate (LA) predicts mortality in septic adults. We sought to determine if serum LA correlated with the diagnosis of sepsis, admission rates, and outcomes in pediatric patients presenting to the ED with suspected infection. Published: 2013.

Key Study: Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study (2013)

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Nijman RGV, Y.; Thompson, M.; Van Veen, M.; Van Meurs, A. H.; Van Der Lei, J....

Objective: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Published: 2013.

Key Study: The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome (2012)

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Scott HFD, A. J.; Gaieski, D. F.; Marchese, R. F.; Mistry, R. D.

Objective: Failure to recognize shock contributes to inadequate early resuscitation in many children with sepsis. Serum lactate levels are used to identify adult patients with septic shock, but physical examination diagnosis alone is recommended in pediatric sepsis. The authors sought to test the utility of lactate testing in pediatric emergency department (ED) patients with systemic inflammatory response syndrome (SIRS). The hypothesis was that early hyperlactatemia (serum lactate >/= 4.0 mmol/L) would be associated with increased risk of organ dysfunction. Published: 2012.

Key Study: Test characteristics of an automated age- and temperature-adjusted tachycardia alert in pediatric septic shock (2012)

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Cruz ATW, E. A.; Graf, J. M.; Perry, A. M.; Harbin, D. E.; Wuestner, E. R.; P...

Objective: This study aimed to create and analyze the performance of an automated triage tool alerting triage nursing staff and physicians to an abnormal heart rate consistent with septic shock in a pediatric emergency department. Published: 2012.

Key Study: Evaluation of temperature-pulse centile charts in identifying serious bacterial illness: observational cohort study (2011)

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Brent AJL, M.; Ninis, N.; Levin, M.; Macfaul, R.; Thompson, M.

Background: Distinguishing serious bacterial infection (SBI) from milder/self-limiting infections is often difficult. Interpretation of vital signs is confounded by the effect of temperature on pulse and respiratory rate. Temperature-pulse centile charts have been proposed to improve the predictive value of pulse rate in the clinical assessment of children with suspected SBI. OBJECTIVES: To assess the utility of proposed temperature-pulse centile charts in the clinical assessment of children with suspected SBI. Published: 2011.

Key Study: Implementation of goal-directed therapy for children with suspected sepsis in the emergency department (2011)

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Cruz ATP, A. M.; Williams, E. A.; Graf, J. M.; Wuestner, E. R.; Patel, B.

Background: Suboptimal care for children with septic shock includes delayed recognition and inadequate fluid resuscitation. OBJECTIVE: To describe the implementation of an emergency department (ED) protocol for the recognition of septic shock and facilitate adherence to national treatment guidelines. Published: 2011.

Key Study: Red blood cell transfusion thresholds in pediatric patients with sepsis (2011)

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Karam OT, M.; Ducruet, T.; Hume, H. A.; Lacroix, J.; Gauvin, F.

Objective: In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome. Published: 2011.

Key Study: An emergency department septic shock protocol and care guideline for children initiated at triage (2011)

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Larsen GYM, N.; Greenberg, R.

Background: Unrecognized and undertreated septic shock increases morbidity and mortality. Septic shock in children is defined as sepsis and cardiovascular organ dysfunction, not necessarily with hypotension. OBJECTIVE: Cases of unrecognized and undertreated septic shock in our emergency department (ED) were reviewed with a focus on (1) increased recognition at triage and (2) more aggressive treatment once recognized. We hypothesized that septic shock protocol and care guideline would expedite identification of septic shock, increase compliance with recommended therapy, and improve outcomes.

Key Study: Pathophysiological aspects of hyperglycemia in children with meningococcal sepsis and septic shock: a prospective, observational cohort study (2011)

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Verhoeven JJDB, M.; Hokken-Koelega, A. C.; Hazelzet, J. A.; Joosten, K. F.

Objective: The objective of this study was to investigate the occurrence of hyperglycemia and insulin response in critically ill children with meningococcal disease in the intensive care unit of an academic children's hospital. Published: 2011.

Key Study: Adjunctive corticosteroid therapy in pediatric severe sepsis: observations from the RESOLVE study (2011)

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Zimmerman JJW, M. D.

Objective: To assess whether corticosteroids, used as adjunctive therapy for pediatric severe sepsis, is associated with improved outcomes. Published: 2011.

Key Study: The relationship between body temperature, heart rate and respiratory rate in children (2009)

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Davies PM, I.

Objective: To describe and quantify the effect that increasing body temperature has on heart rate and respiratory rate in children attending a paediatric emergency department (ED). Published: 2009.

Key Study: How well do vital signs identify children with serious infections in paediatric emergency care? (2009)

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Thompson MC, N.; Harnden, A.; Mayon-White, R.; Perera, R.; Mant, D.

Objective: To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors. Published: 2009.

Key Study: Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit (2009)

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Inwald DPT, R. C.; Peters, M. J.; Nadel, S.

Objective: To audit current UK practice of the management of severe sepsis in children against the 2002 American College of Critical Care Medicine/Pediatric Advanced Life Support (ACCM-PALS) guideline. Published: 2009.

Key Study: Vasopressin in pediatric vasodilatory shock: a multicenter randomized controlled trial (2009)

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Choong KB, D.; Fraser, D. D.; Gaboury, I.; Hutchison, J. S.; Joffe, A. R.; Li...

Rationale: Vasopressin has been proposed as a potent vasoactive agent in the treatment of vasodilatory shock in adults and children. The objective of this trial was to evaluate the efficacy and safety of vasopressin as an adjunctive agent in pediatric vasodilatory shock. Published: 2009.

Key Study: Hydrocortisone therapy for patients with septic shock (2008)

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Sprung CLA, D.; Keh, D.; Moreno, R.; Singer, M.; Freivogel, K.; Weiss, Y. G.;...

Background: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Published: 2008.

Key Study: Serum lactate as a predictor of mortality in patients with infection (2007)

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Trzeciak SD, R. P.; Chansky, M. E.; Arnold, R. C.; Schorr, C.; Milcarek, B.; ...

Objective: To determine the utility of an initial serum lactate measurement for identifying high risk of death in patients with infection. DESIGN AND SETTING: Post-hoc analysis of a prospectively compiled registry in an urban academic hospital. Published: 2007.

Key Study: Rapid fluid resuscitation in pediatrics: testing the American College of Critical Care Medicine guideline (2007)

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Stoner MJG, D. G.; Cohen, D. M.; Fernandez, S. A.; Hall, M. W.

Objective: The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use of a manual push-pull system will permit guideline adherence. Published: 2007.

Key Study: Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock (2005)

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Upadhyay MS, S.; Murlidharan, J.; Kaur, N.; Majumdar, S.

Objective: To compare the efficacy of crystalloid (Normal saline) and colloid (polymer from degraded Gelatin in saline Haemaccel) intravenous fluid in restoration of circulating volume in children with septic shock. Published: 2005.

Key Study: International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics (2005)

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Goldstein BG, B.; Randolph, A.

Objective: Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. Published: 2005.

Key Study: Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome (2003)

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Han YYC, J. A.; Dragotta, M. A.; Bills, D. M.; Watson, R. S.; Westerman, M. E...

Objective: Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock recommend this therapeutic approach. The objective of this study was to determine whether early septic shock reversal and use of resuscitation practice consistent with the new ACCM-PALS Guidelines by community physicians is associated with improved outcome. Published: 2003.

Key Study: Early goal-directed therapy in the treatment of severe sepsis and septic shock (2001)

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Rivers EN, B.; Havstad, S.; Ressler, J.; Muzzin, A.; Knoblich, B.; Peterson, ...

Background: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. Published: 2001.

Key Study: Role of early fluid resuscitation in pediatric septic shock (1991)

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Carcillo JaD, A. L.; Zaritsky, A.

Objective: To examine the association of the volume of fluid administered at 1 and 6 hours after presentation, with survival and the occurrence of the adult respiratory distress syndrome, cardiogenic pulmonary edema, and persistent hypovolemia during the resuscitation of children with septic shock. Published: 1991.

Key Study: Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection (2013)

Visit

Reed LC, J.; Cummings, A.; Markwell, S.; Wall, J.; Duong, M.

Objective: No single reliable sepsis biomarker exists for risk stratification and prognostication in pediatric patients presenting to the emergency department (ED). Serum lactate (LA) predicts mortality in septic adults. We sought to determine if serum LA correlated with the diagnosis of sepsis, admission rates, and outcomes in pediatric patients presenting to the ED with suspected infection. Published: 2013.

Key Study: Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study (2013)

Visit

Nijman RGV, Y.; Thompson, M.; Van Veen, M.; Van Meurs, A. H.; Van Der Lei, J....

Objective: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Published: 2013.

Key Study: The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome (2012)

Visit

Scott HFD, A. J.; Gaieski, D. F.; Marchese, R. F.; Mistry, R. D.

Objective: Failure to recognize shock contributes to inadequate early resuscitation in many children with sepsis. Serum lactate levels are used to identify adult patients with septic shock, but physical examination diagnosis alone is recommended in pediatric sepsis. The authors sought to test the utility of lactate testing in pediatric emergency department (ED) patients with systemic inflammatory response syndrome (SIRS). The hypothesis was that early hyperlactatemia (serum lactate >/= 4.0 mmol/L) would be associated with increased risk of organ dysfunction. Published: 2012.

Key Study: Test characteristics of an automated age- and temperature-adjusted tachycardia alert in pediatric septic shock (2012)

Visit

Cruz ATW, E. A.; Graf, J. M.; Perry, A. M.; Harbin, D. E.; Wuestner, E. R.; P...

Objective: This study aimed to create and analyze the performance of an automated triage tool alerting triage nursing staff and physicians to an abnormal heart rate consistent with septic shock in a pediatric emergency department. Published: 2012.

Key Study: Evaluation of temperature-pulse centile charts in identifying serious bacterial illness: observational cohort study (2011)

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Brent AJL, M.; Ninis, N.; Levin, M.; Macfaul, R.; Thompson, M.

Background: Distinguishing serious bacterial infection (SBI) from milder/self-limiting infections is often difficult. Interpretation of vital signs is confounded by the effect of temperature on pulse and respiratory rate. Temperature-pulse centile charts have been proposed to improve the predictive value of pulse rate in the clinical assessment of children with suspected SBI. OBJECTIVES: To assess the utility of proposed temperature-pulse centile charts in the clinical assessment of children with suspected SBI. Published: 2011.

Key Study: Implementation of goal-directed therapy for children with suspected sepsis in the emergency department (2011)

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Cruz ATP, A. M.; Williams, E. A.; Graf, J. M.; Wuestner, E. R.; Patel, B.

Background: Suboptimal care for children with septic shock includes delayed recognition and inadequate fluid resuscitation. OBJECTIVE: To describe the implementation of an emergency department (ED) protocol for the recognition of septic shock and facilitate adherence to national treatment guidelines. Published: 2011.

Key Study: Red blood cell transfusion thresholds in pediatric patients with sepsis (2011)

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Karam OT, M.; Ducruet, T.; Hume, H. A.; Lacroix, J.; Gauvin, F.

Objective: In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome. Published: 2011.

Key Study: An emergency department septic shock protocol and care guideline for children initiated at triage (2011)

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Larsen GYM, N.; Greenberg, R.

Background: Unrecognized and undertreated septic shock increases morbidity and mortality. Septic shock in children is defined as sepsis and cardiovascular organ dysfunction, not necessarily with hypotension. OBJECTIVE: Cases of unrecognized and undertreated septic shock in our emergency department (ED) were reviewed with a focus on (1) increased recognition at triage and (2) more aggressive treatment once recognized. We hypothesized that septic shock protocol and care guideline would expedite identification of septic shock, increase compliance with recommended therapy, and improve outcomes.

Key Study: Pathophysiological aspects of hyperglycemia in children with meningococcal sepsis and septic shock: a prospective, observational cohort study (2011)

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Verhoeven JJDB, M.; Hokken-Koelega, A. C.; Hazelzet, J. A.; Joosten, K. F.

Objective: The objective of this study was to investigate the occurrence of hyperglycemia and insulin response in critically ill children with meningococcal disease in the intensive care unit of an academic children's hospital. Published: 2011.

Key Study: Adjunctive corticosteroid therapy in pediatric severe sepsis: observations from the RESOLVE study (2011)

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Zimmerman JJW, M. D.

Objective: To assess whether corticosteroids, used as adjunctive therapy for pediatric severe sepsis, is associated with improved outcomes. Published: 2011.

Key Study: The relationship between body temperature, heart rate and respiratory rate in children (2009)

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Davies PM, I.

Objective: To describe and quantify the effect that increasing body temperature has on heart rate and respiratory rate in children attending a paediatric emergency department (ED). Published: 2009.

Key Study: How well do vital signs identify children with serious infections in paediatric emergency care? (2009)

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Thompson MC, N.; Harnden, A.; Mayon-White, R.; Perera, R.; Mant, D.

Objective: To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors. Published: 2009.

Key Study: Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit (2009)

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Inwald DPT, R. C.; Peters, M. J.; Nadel, S.

Objective: To audit current UK practice of the management of severe sepsis in children against the 2002 American College of Critical Care Medicine/Pediatric Advanced Life Support (ACCM-PALS) guideline. Published: 2009.

Key Study: Vasopressin in pediatric vasodilatory shock: a multicenter randomized controlled trial (2009)

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Choong KB, D.; Fraser, D. D.; Gaboury, I.; Hutchison, J. S.; Joffe, A. R.; Li...

Rationale: Vasopressin has been proposed as a potent vasoactive agent in the treatment of vasodilatory shock in adults and children. The objective of this trial was to evaluate the efficacy and safety of vasopressin as an adjunctive agent in pediatric vasodilatory shock. Published: 2009.

Key Study: Hydrocortisone therapy for patients with septic shock (2008)

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Sprung CLA, D.; Keh, D.; Moreno, R.; Singer, M.; Freivogel, K.; Weiss, Y. G.;...

Background: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Published: 2008.

Key Study: Serum lactate as a predictor of mortality in patients with infection (2007)

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Trzeciak SD, R. P.; Chansky, M. E.; Arnold, R. C.; Schorr, C.; Milcarek, B.; ...

Objective: To determine the utility of an initial serum lactate measurement for identifying high risk of death in patients with infection. DESIGN AND SETTING: Post-hoc analysis of a prospectively compiled registry in an urban academic hospital. Published: 2007.

Key Study: Rapid fluid resuscitation in pediatrics: testing the American College of Critical Care Medicine guideline (2007)

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Stoner MJG, D. G.; Cohen, D. M.; Fernandez, S. A.; Hall, M. W.

Objective: The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use of a manual push-pull system will permit guideline adherence. Published: 2007.

Key Study: Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock (2005)

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Upadhyay MS, S.; Murlidharan, J.; Kaur, N.; Majumdar, S.

Objective: To compare the efficacy of crystalloid (Normal saline) and colloid (polymer from degraded Gelatin in saline Haemaccel) intravenous fluid in restoration of circulating volume in children with septic shock. Published: 2005.

Key Study: International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics (2005)

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Goldstein BG, B.; Randolph, A.

Objective: Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. Published: 2005.

Key Study: Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome (2003)

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Han YYC, J. A.; Dragotta, M. A.; Bills, D. M.; Watson, R. S.; Westerman, M. E...

Objective: Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock recommend this therapeutic approach. The objective of this study was to determine whether early septic shock reversal and use of resuscitation practice consistent with the new ACCM-PALS Guidelines by community physicians is associated with improved outcome. Published: 2003.

Key Study: Early goal-directed therapy in the treatment of severe sepsis and septic shock (2001)

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Rivers EN, B.; Havstad, S.; Ressler, J.; Muzzin, A.; Knoblich, B.; Peterson, ...

Background: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. Published: 2001.

Key Study: Role of early fluid resuscitation in pediatric septic shock (1991)

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Carcillo JaD, A. L.; Zaritsky, A.

Objective: To examine the association of the volume of fluid administered at 1 and 6 hours after presentation, with survival and the occurrence of the adult respiratory distress syndrome, cardiogenic pulmonary edema, and persistent hypovolemia during the resuscitation of children with septic shock. Published: 1991.