696 - Exploring the Impact of Altered Mental Status on Morbidity and Mortality in Pediatric Sepsis: A Retrospective Cohort Study

Publication Number: 3673.696

Timothy Scranton, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Ioannis Koutroulis, Children's National Health System, Washington, DC, United States

Background:

Background: Sepsis, a life-threatening immune response to infection, is a leading cause of pediatric morbidity and mortality. Neurological complications are frequently present in septic patients, leading to altered mental status (AMS). In severe cases, AMS can indicate sepsis-associated encephalopathy (SAE), a diffuse brain dysfunction with mortality rates reported to reach 70%. Despite its adverse outcomes, AMS remains underrecognized in septic patients and it is often assessed using the Glasgow Coma Scale (GCS), a tool originally developed for trauma patients.

Objective:

Objective: To determine the frequency of AMS documentation among pediatric septic patients presenting to the emergency department (ED) and to evaluate if AMS at presentation predicts clinical outcomes and mortality.

Design/Methods:

Design/Methods: 68 patients aged 0-19 years treated for sepsis in an ED of an urban pediatric tertiary hospital from 2022 to 2025 were included in the study. AMS was defined as a GCS < 15 within the first six hours after triage or by documentation in physician notes. Suspected sepsis was defined as receiving two fluid boluses and antibiotics, or by diagnosis by a provider. The outcomes measures included time to fluids and antibiotics, fluid amount, inflammatory markers at admission, blood culture positivity, need for ventilatory support, intensive care unit (ICU) admission, hospital LOS, and mortality. Continuous variables were assessed using t-tests, categorical variables were assessed using chi-square or Fisher's exact tests (p < 0.05 was considered significant).

Results:

Results: Out of the 68 patients analyzed, GCS scores were documented by nurses for 32 patients (47.1%), while only 1 patient (1.47%) had a GCS score documented by a physician. 20 patients (29.4%) had AMS, and the average GCS Score for these patients was 9.71 (95% CI: 7.8-11.6). Patients with AMS had significantly higher serum lactate levels (p=0.014) and procalcitonin levels (p=0.038) at admission compared to those without AMS. There were no statistically significant differences found between patients with and without AMS with respect to time to antibiotics, time to fluids, fluid amount, white blood cell count, C-reactive protein, creatinine, blood culture positivity, ICU admission, ICU and hospital LOS, need for ventilatory support, or mortality.

Conclusion(s):

Conclusions: AMS was inconsistently documented among pediatric septic patients. AMS was not significantly associated with most clinical outcomes such as mortality and LOS, but markers such as lactate and procalcitonin were significantly higher among AMS patients.