105 - Critical Components in Pediatric Sepsis Recognition and Management: A Delphi Study

Poster Number: 105
Publication Number: 105.307

Tina Sosa, Golisano Children's Hospital at The University of Rochester Medical Center, WEBSTER, NY, United States; Daniel Schumacher, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Holly Depinet, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States; Jerome Schwartz, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Matthew W. Zackoff, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Despite success in the development and implementation of evidence-based care algorithms for pediatric sepsis, the early recognition of sepsis, which is critical to algorithm implementation, remains fraught with challenges. Opportunity remains to leverage human factors and clinician expertise to ensure critical and subtle components of sepsis recognition and management are optimally incorporated into educational interventions.

Objective: To describe the factors that inform expert front-line pediatric care provider situation awareness during the recognition and management of sepsis.

Design/Methods: This single center Delphi study of clinical experts from the pediatric intensive care unit and the emergency department convened one panel of 10 nurses and one panel of 10 physicians to determine the factors most important to pediatric sepsis recognition and management across 3 domains: 1) key clinical findings, 2) challenges, and 3) decision points (Figure 1). The study was comprised of three rounds of individually completed surveys, consisting of open-ended factor collection, verification, and repeated ranking of factor importance (Figure 1). Ranking consensus was defined as 70% agreement among panelists. Comparisons were drawn both between panels and within panels by subspecialty.  

Results: Nurse and physician panelists reached consensus that patient risk status, unique considerations for children with medical complexity, markers of perfusion, and the speed of and response to resuscitative efforts are critical factors for the recognition and management of pediatric sepsis (Table 1). Nurses placed increased value upon certain laboratory study factors (including complete blood count and procalcitonin) as compared to physicians. Physicians placed increased emphasis on details related to fluid and vasoactive medication administration and response. (Table 1). Conclusion(s): Multiple historical and objective factors reached consensus as critical to expert nurses and physicians in the recognition and management of pediatric sepsis. This foundational data can be utilized by sepsis, implementation science, and educational experts to explore the differences between novice and expert clinicians, and leverage this knowledge to develop and assess new interdisciplinary interventions (e.g. virtual reality simulation training) to close the gaps in sepsis care.
Figure 1. Delphi Panel Methodology.This study consisted of two concurrent Delphi panels conducted in parallel to solicit factors for two populations of expert front-line care providers: nurses and physicians.
Table 1. Delphi Panel Results.Factors collected from both panels are shown, depicting which factors reached consensus versus those that did not reach consensus for each ranking level per domain. CBC – complete blood count, CSF – cerebrospinal fluid, ECMO – extracorporeal membrane oxygenation, ED – emergency department, XR – X-ray.