Effectiveness of physical exam signs for early detection of critical illness in pediatric systemic inflammatory response syndrome

BMC Emergency Medicine

Research Article

David F Gaieski¹  Rakesh D Mistry²  Halden F Scott²  Ronald F Marchese³  Aaron J Donoghue⁴ 

[1] Department of Emergency Medicine, The Hospital of the University of Pennsylvania, 3400 Spruce Street, 19104, Philadelphia, PA, USA;The Center for Resuscitation Science, The Hospital of the University of Pennsylvania, 3400 Spruce Street, 19104, Philadelphia, PA, USA;Section of Emergency Medicine, Department of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine, 13123 East 16th Avenue, B251, 80045, Aurora, CO, USA;Section of Emergency Medicine, Department of Pediatrics, The Children’s Hospital of Philadelphia, 34th Street & Civic Center Boulevard, 19104, Philadelphia, PA, USA;Section of Emergency Medicine, Department of Pediatrics, The Children’s Hospital of Philadelphia, 34th Street & Civic Center Boulevard, 19104, Philadelphia, PA, USA;Department of Anesthesia & Critical Care, The Children’s Hospital of Philadelphia, 3400 Spruce Street, 19104, Philadelphia, PA, USA;

关键词: Sepsis;    Systemic inflammatory response syndrome;    Pediatrics;    Physical examination;    Emergency medicine;   

DOI  :  10.1186/1471-227X-14-24

 received in 2014-03-05, accepted in 2014-10-30,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundEarly detection of compensated pediatric septic shock requires diagnostic tests that are sensitive and specific. Four physical exam signs are recommended for detecting pediatric septic shock prior to hypotension (cold extremities, mental status, capillary refill, peripheral pulse quality); this study tested their ability to detect patients who develop organ dysfunction among a cohort of undifferentiated pediatric systemic inflammatory response syndrome patients.MethodsA prospective cohort of 239 pediatric emergency department patients <19 years with fever and tachycardia and undergoing phlebotomy were enrolled. Physicians recorded initial physical exams on a standardized form. Abstraction of the medical record determined outcomes including organ dysfunction, intensive care unit stay, serious bacterial infection, and therapies.ResultsOrgan dysfunction occurred in 13/239 (5.4%) patients. Presence of at least one sign was significantly associated with organ dysfunction (Relative Risk: 2.71, 95% CI: 1.05–6.99), and presence of at least two signs had a Relative Risk = 4.98 (95% CI: 1.82–13.58). The sensitivity of exam findings ranged from 8–54%, specificity from 84–98%. Signs were associated with increased risk of intensive care and fluid bolus, but not with serious bacterial infection, intravenous antibiotics or admission. Altered mental status and peripheral pulse quality were significantly associated with organ dysfunction, while abnormal capillary refill time and presence of cold, mottled extremities were not.ConclusionsCertain recommended physical exam signs were associated with increased risk of organ dysfunction, a rare outcome in this undifferentiated pediatric population with fever and tachycardia. Sensitivity was low, while specificity was high. Additional research into optimally sensitive and specific diagnostic strategies is needed.

【 授权许可】

CC BY   
© Scott et al.; licensee BioMed Central Ltd. 2014