O3289: The Impact of Screening for Critical Sepsis During Pediatric Interfacility Transport

Background: Despite improvements in early recognition and resuscitation, sepsis remains a major pediatric health issue with an estimated 40,000 hospitalizations and 5,000 deaths every year in the US. Early recognition and resuscitation improve outcomes. As part of the Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes (IPSO) Collaborative, Arkansas Children’s Hospital (ACH) screens for sepsis and critical sepsis (severe sepsis/septic shock) in the emergency department, all medical-surgical wards, and all intensive care units. The Angel One Transport team at ACH recently began screening for critical sepsis during interfacility transport. We hypothesized that screening for critical sepsis during interfacility transports would lead to improved recognition and enhanced resuscitation prior to tertiary care center arrival.

Methods: A critical sepsis screening tool was constructed to identify pediatric patients at risk for critical sepsis (Figure 1). The screening tool was adopted from a previously validated tool now incorporated into the electronic medical record in the ACH PICU. All pediatric transports from November 2022 through March 2023 were screened and data was collected on clinical screening criteria, laboratory screening criteria, resuscitative interventions, and ground times. Student’s t-test was used to compare categorical variables and chi-square for proportions.

Results: 107 pediatric interfacility transport patients were screened for critical sepsis; 41.1% (N=44) screened positive. In comparison, screening positivity rate in the ACH PICU is 5.5% (p < 0.0001). 42 patients met clinical screening criteria including capillary refill >3 seconds (59.1%), acutely altered mental status (40.9%), previous administration of >40ml/kg IVF (45.5%), and hypotension (9.1%). 2 patients not meeting clinical screening criteria met laboratory screening criteria (abnormal WBC, elevated CRP, thrombocytopenia). 10 patients (22.7%) met both clinical and laboratory screening criteria. Additional resuscitation by the transport team occurred in 40.9% (N=18), including IVF boluses (61.1%) and IV antibiotics (38.9%). Ground times were longer in patients who screened positive for critical sepsis (62.26+/-6.63 minutes vs. 48.15+/-4.46 minutes, p< 0.0001). Hospital LOS was 12.73+/-7.78 days and mortality 0.75% in this cohort.

Conclusion: In this single center cohort of pediatric interfacility transport patients, a large percentage screened positive for critical sepsis. The majority of positive screens required additional resuscitation during transport. Additional investigation is needed to determine the impact of early recognition and resuscitation of pediatric septic shock by specialized transport teams prior to tertiary care center arrival.