445 - The Epidemiology and Clinical Presentation of Pediatric Sepsis in the Prehospital Setting

Publication Number: 4436.445

Molly Schneider, Children's National Health System, Washington, DC, United States; Michael L. Cohen, Emergency Medical Services Institute, Santa Fe Community College, Albuquerque, NM, United States; Kimberly Kleschick, Intermountain Health, Denver, CO, United States; Thomas J. McAdam, New York Medical College, Valhalla, NY, United States; Catherine A. Plumb, Buckingham County Department of Emergency Services, Scottsville, VA, United States; David Wampler, UT Health Science Center at San Antonio, San Antonio, TX, United States; Lawrence H. Brown, University of Texas at Austin Dell Medical School, Austin, TX, United States

Background: Sepsis leads to morbidity and mortality in children, but early recognition and antibiotic treatment improve clinical outcomes. Understanding the epidemiology and clinical presentation of pediatric sepsis in the prehospital setting could improve identification, emergency medical services (EMS) clinical care, and early emergency department (ED) notification.

Objective: To describe the prevalence and clinical presentation of sepsis in the prehospital setting.

Design/Methods: We performed a retrospective study of pediatric ( < 18 years old) EMS encounters from the ESO Data Collaborative, a database of patient records from EMS agencies across the United States. The sample included patients from 2023 - 2024 with linked EMS and hospital outcome data available who had a sepsis-related ICD-10 code in the ED or hospital record. Trauma patients and those with ICD-10 codes indicating hospital-acquired infection were excluded. Abnormal vital signs were defined as >95th or < 5th percentile based on age-specific norms.

Results: Among 1.5 million pediatric EMS encounters, 850,000 patients (57%) were transported to the hospital. Linked hospital outcome data was available for 211,000 transported patients (25%), of which 669 (0.3%) had an ED or hospital sepsis diagnosis. The age breakdown was infants < 1 year (27%), 1-5 (23%), 6-12 (20%), and >12-year-olds (29%) (Table 1). The most common prehospital clinician impressions were respiratory-related (29%) and fever (11%). Sepsis was rarely the documented impression (7%).

Heart rate, respiratory rate, and oxygen saturation were consistently recorded (>90%), and tachycardia (61%), tachypnea (40%), and hypoxia (18%) were commonly observed (Figures 1 and 2). Temperature was recorded for less than half of patients, but those patients were frequently febrile (40%). Systolic blood pressure (SBP) was recorded for only half of infants. Compared to all age groups, infants had more hypotension and less tachypnea and tachycardia, which may reflect measurement error.

Conclusion(s): Three in 1,000 pediatric EMS transports involve a child with sepsis, and respiratory-related presentations are most prevalent. Sepsis is rarely documented in the prehospital clinical impression; therefore, improving clinical suspicion for sepsis and identification of this life-threatening diagnosis is key. Opportunities to improve prehospital sepsis care may include increasing temperature and blood pressure recording, and determining which sepsis patients require transport to designated pediatric specialty centers. Development of a prehospital pediatric sepsis screening tool could help with these efforts.

Table 1
Sample characteristics including demographics, prehospital level of care, prehospital interventions, and patient outcomes.

Figure 1
Rate of prehospital vital sign documentation by age group for patients with sepsis.

1Systolic Blood Pressure; 2Heart Rate; 3Respiratory Rate; 4Oxygen Saturation

Figure 2
Rate of prehospital vital sign abnormality by age group for patients with sepsis. *p < 0.05