A team of Liverpool researchers has developed a novel bedside tool to improve the detection of serious infections in children.
The LqSOFA (Liverpool Sequential Organ Failure Assessment Score) is an adjustment of the age-adjusted qSOFA score, a bedside prompt to identify patients with suspected infection at a higher risk of poor outcomes outside of the ICU. In over 12,000 febrile children who presented to the emergency room and were subsequently identified from the NHS Foundation Trust electronic medical record by Alder Hey Children, the score was able to accurately predict children entering critical care within 48 hours.
“Most febrile children presenting to the emergency room have self-limiting or mild illness, and those with severe bacterial infections and sepsis are the needle in the haystack,” said senior researcher Professor Enitan Carrol of the University of Liverpool.
“The challenge for doctors in the pediatric emergency room is to accurately and quickly identify children with severe bacterial infection and sepsis so that urgent treatment can be delivered and poor outcomes such as ICU admission and death avoided,” she adds.
The score uses four vital signs that can be measured at the bedside in under two minutes with just a watch. These are heart rate, breathing rate, level of consciousness (on an alarm / speech / pain / unresponsive scale), and capillary refill time (a measure of perfusion). Compared to the original qSOFA, the new score does not require a blood pressure measurement, which is omitted in around two-thirds of children who present themselves to the emergency room. This makes the score ideal for pre-clinical settings such as primary care, ambulance, emergency care, and low income settings.
The study also found that the Alder Hey Pediatric Early Warning Score (PEWS), which is used to determine deterioration in hospitalized patients, has a high discriminatory value for predicting critical care admission in febrile children in the emergency room. PEWS scores often contain several other variables and are therefore more complicated and time consuming to calculate.
Professor Enitan Carrol said, “What I’m most proud of about this project is that the work has been done almost entirely by aspiring doctors who worked tirelessly to complete the Herculean task of extracting the data and calculating the results . “
Dr. Sam Romaine, a clinical research fellow and lead author on the study, said, “Improving our detection of these serious infections is a really important area of research, so I am very proud to have contributed to this study.”
Dr. Jessica Potter, whose medical student research project first derived the score, said, “When I started the project in medical school, I never imagined the impact the research could have. I had the opportunity to be part of a research project that has become an important piece of work, allowing me to start my medical career building skills that I can use during my early years and beyond. “
To the team’s knowledge, this is the largest study evaluating the performance of rapid assessment results, including qSOFA, in a pediatric emergency room. The population reflects a real emergency room with a high income and a low prevalence of sepsis.
“Overall, the results of the study demonstrate the superior performance of the Liverpool qSOFA and challenge the use of the original qSOFA to identify children at risk of sepsis in the pediatric emergency room,” concludes Professor Carrol.
The other Liverpool employees were Dr. Rachel McGalliard (NIHR Academic Clinical Fellow), Dr. Aakash Khanijau (Clinical Research Fellow) and Dr. Gemma Wright (Children’s Chancellor, Alder Hey Children’s Hospital).
Researchers from the Center for Study Research in Cardiff and the Pediatric Intensive Care Unit at Queensland Children’s Hospital in Australia also contributed to the work.
The study was published in Pediatrics, the official journal of the American Academy of Pediatrics.
The fast SOFA score predicts the risk of mortality in the hospital
Sam T. Romaine et al. Accuracy of a Modified qSOFA Score for Predicting Critical Care Intake in Febrile Children, Pediatrics (2020). DOI: 10.1542 / peds.2020-0782 Provided by the University of Liverpool
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