683 - Pediatric Sepsis in General Emergency Departments: Factors Associated with Timely Diagnosis and the Role of Transfer Calls with Children's Hospitals

Publication Number: 3660.683

Halden F. Scott, University of Colorado School of Medicine, Denver, CO, United States; Daniel M. Lindberg, University of Colorado Anschutz Medical Campus, Denver, CO, United States; Joseph A. Grubenhoff, University of Colorado School of Medicine, AURORA, CO, United States; Kaitlyn B. Bertin, University of Colorado School of Medicine, Denver, CO, United States; Carter Sevick, University of Colorado School of Medicine, Aurora, CO, United States; Jenna T. Jordan, University of Colorado School of Medicine, Aurora, CO, United States; Alison Saville, University of Colorado School of Medicine, Denver, CO, United States; Ashley C. Dafoe, University of Colorado School of Medicine, Thornton, CO, United States; Bentley Porterfield-Finn, University of Colorado School of Medicine, Denver, CO, United States; Caroline I. Tietbohl, University of Colorado Anschutz, Aurora, CO, United States; Allison Kempe, University of Colorado AMC and ACCORDS, denver, CO, United States

Background: Delayed diagnosis of pediatric sepsis is a leading cause of failure to deliver timely, lifesaving treatment. Most children with sepsis first receive emergency care in general Emergency Departments (EDs) where pediatric sepsis is a rare event, and research limited.

Objective: 1) To characterize sepsis diagnosis in children in general EDs transferred to children's hospitals; 2) to identify factors associated with timely diagnosis.

Design/Methods: This retrospective IRB-approved cohort study included patients transferred to 4 pediatric hospitals who had Phoenix sepsis 1) in the referring ED, 2) during transport, or 3) within 6 hours of pediatric hospital arrival. Encounters were identified in pediatric hospitals' sepsis and transfer registry. Transfer call recordings were professionally transcribed and reviewed by qualitative researchers. Structured medical record review was conducted. The primary outcome was timely sepsis diagnosis and treatment initiation at the referring hospital with IV antibiotics and bolus fluid. Diagnosis required the word sepsis in the referring chart or the referring provider proposing or accepting a diagnosis of sepsis on the transfer call. Pre-specified variables were tested for their association with diagnosis (age, chronic condition, fever, transfer distance, hospital rurality, accepting physician type, vital signs reported, Phoenix score).

Results: 88 sepsis transfer encounters from 55 referring EDs in 5 states were included from 1/2023-8/2024 [Fig 1]. Timely sepsis diagnosis occurred in 53 encounters (60%, 95% CI: 49-71%). When sepsis was diagnosed, the diagnosis of sepsis was first suggested by the accepting pediatric physician in 31 (58%) encounters. The median transfer call duration was 14 minutes when sepsis was diagnosed vs. 12 minutes in undiagnosed encounters. Three factors were associated with timely sepsis diagnosis: fever recorded in ED, vital signs discussed during transfer call, and older age [Tab 1]. Median time from transfer call to pediatric hospital arrival was >3 hours. Mortality or ECMO occurred in 8% [Tab 2].

Conclusion(s): Across 55 general EDs, pediatric sepsis was not diagnosed in 40% of encounters. Pediatric physicians facilitated sepsis diagnosis during many transfer calls. A potentially modifiable factor associated with timely diagnosis was vital sign discussion on transfer calls. Despite the importance of mandated transfer calls in emergency care, few studies have analyzed these calls, or tested interventions. Transfer calls are an under-studied tool already in use, with potential to improve diagnosis and pediatric emergency preparedness in sepsis.

Figure 1. Map of referring Emergency Departments included in the study.


Table 1.
Pre-specified variables assessed for significant difference between encounters with and without sepsis diagnosed at the referring hospital. Results reported as median [interquartile range] and n (%).

Table 2.
Referring hospital and pediatric hospital course and outcomes. Results reported as median [interquartile range] and n (%).