O1028: Usefulness of a National Sepsis Screening Tool for Detection of Bacteremia or Meningitis in a Pediatric Emergency Department

Background: A national sepsis screening tool based on presence of tachycardia and clinical features of infection was implemented at our tertiary pediatric emergency department (ED). Bacteremia and meningitis pose a significant risk for development of septic shock and are associated with severe morbidity and mortality. The objective of this project was to assess the local performance of the sepsis-screening tool specifically for identifying patients with bacterial meningitis or bacteremia in our ED.

Methods: As part of an ongoing quality improvement initiative to implement the Canadian Association of Paediatric Health Centres (CAPHC) screening tool, a retrospective cohort analysis was conducted to assess the performance of the tool in identifying patients with bacteremia and/or meningitis. Electronic medical records from our ED were reviewed over a one-year period. An analytics database identified all children for whom the sepsis alert was triggered. All positive cerebral spinal fluid (CSF) and blood culture cases were reviewed. Sensitivity, specificity, positive- and negative- predictive values of the use of the tool for this purpose were calculated.

Results: 73,195 patients were triaged in the ED over one year. Of those children 13.6% screened positive for potential sepsis. One hundred positive blood cultures and nine positive CSF cultures with suspected pathogens were identified. The sensitivity and specificity of the screening process in identifying bacteremia was 53.0% (CI 42.8- 63.1) and 86.5% (CI 86.2-86.7) respectively. The positive and negative predictive values for bacteremia were 5.3% and 99.9% respectively. For meningitis, the sensitivity and specificity of the screen was 55.6% (CI 21.2-86.3) and 86.4% (CI 86.2-86.7) respectively with a positive predictive value of 0.05% and negative predictive value of 99.9%. Health record review for children with positive cultures revealed several cases in which the tool prompt regarding presence of signs of infection was answered incorrectly (Tables 1 and 2).

Conclusion: Clinicians should be aware that children with bacteremia or meningitis, conditions associated with a high risk of developing severe morbidity including sepsis, may not have a significantly elevated heart rate or other signs of sepsis at the time of their ED arrival. While the tool provides a mechanism by which patients with possible sepsis can be prioritized, our data suggest that the sepsis screen alone was not a reliable method for detecting all cases of bacteremia or meningitis. Furthermore, our work highlights additional potential limitations of sepsis screening tools that rely on subjective human assessment and demonstrates the importance of high-reliability application of such tools.