Model predicts chance of septic shock in children

Researchers at the University of Colorado Anschutz Medical Campus have developed a novel method for predicting which children arriving in emergency departments (ED) are most likely to go into septic shock. Septic shock occurs when a severe infection causes blood pressure to plummet. Too often, clinicians fail to recognise early sepsis in time to prevent shock.

To develop the method, the researchers ran electronic medical records through a modern predictive algorithm to accurately project the likelihood of septic shock. The results are published in The Journal of Pediatrics.

“No models exist to predict the risk of septic shock upon arrival to the ED, a critical time point for intervention,” said study lead author Halden Scott, Associate Professor of Pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado.

“We set out to develop a model of the risk based on patients whom doctors suspected had sepsis upon arrival.”

The study examined six paediatric ED and urgent care sites, focusing on patients 60 days to 18 years old whom doctors suspected might have sepsis and missed cases of septic shock.

Of 2464 visits analysed, septic shock occurred in 282 cases (11.4%) — the model was able to predict 90% of these cases.

“This model estimated risk of septic shock in children at hospital arrival, earlier than existing models,” Scott said. “Using it offers the potential to enhance clinical risk-stratification in the critical moments before a patient begins to deteriorate.”

In a high-risk patient, treatment could begin earlier to prevent shock. Sepsis treatment includes antibiotics, fluid resuscitation, close monitoring and hospital admission.

“The model is an equation designed for computer-based calculation, in order to maximise the predictive value of data already in the electronic health record,” Scott explained.

A recent study in New York state showed that only 24.9% of children with sepsis received what’s known as the first-hour ‘bundle’, which includes IV fluid, IV antibiotics and blood cultures.

Scott said that study was further evidence that most children fail to get the necessary treatment when it could possibly save their lives.

“The early treatment for sepsis is relatively simple, but if it’s not given early, a downward spiral of organ failure can begin that is difficult to reverse,” she said.

“This is why we believe that a predictive model for septic shock is so important to improve early diagnosis and get early treatment to the high-risk patients for whom it can be life-saving.”

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