368 - Association between triage temperature and timeliness of sepsis interventions in a pediatric emergency department: a single-center retrospective cohort study

Poster Number: 368
Publication Number: 368.312

McKenna Murphy, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States; John M. Morrison, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Jamie L. Fierstein, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States; Racha T. Khalaf, University of South Florida, Tampa, FL, United States; Laleh Bahar-Posey, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States; Diana Young, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Elliot Melendez, Connecticut Childrens Hospital, Avon, CT, United States

Background: Fever as an indicator of infection is frequently utilized as an aid in triggering a concern for sepsis in emergency centers (EC). Adults with sepsis presenting to the EC with a normal temperature have been shown to have delays in sepsis treatment and greater mortality. The association between triage temperature and timeliness of sepsis-related care in the EC remains poorly characterized in children.

Objective: Investigate the association between EC triage temperature and the time to initiation of antibiotic treatment and fluid bolus among children with clinically defined sepsis.

Design/Methods: We conducted a single-center, retrospective cohort study of patients 0-20 years presenting to the EC from 1/1/2017 to 2/28/2021 meeting the Children’s Hospital Association Improving Pediatric Sepsis Outcomes Collaborative operational definition of sepsis. Data collected from an existing quality improvement database were supplemented via chart extraction. Triage temperature was assessed, and the primary outcomes were time from arrival to EC and administration of antibiotics and fluid bolus. Data were summarized by categories of temperature and outcomes compared with Kruskal-Wallis, Chi-square, or Fisher’s exact tests. P-values < .05 were deemed statistically significant. 

Results: There were 388 patients analyzed in this study. Approximately 5.9% (n=23) of patients had triage temperatures ≤36.0oC, while 25.3% (n=98) had temperatures 36.1-37.9oC, and 68.8% (n=267) temperatures ≥38.0oC. Demographic and clinical information is summarized in Table 1. The prevalence of high-risk conditions for developing sepsis including malignancy, indwelling venous catheter, bone marrow/solid organ transplant, immunocompromise, or technology dependence did not differ between groups (p>.05 for all). Primary and secondary outcomes are summarized in Table 2. The median time to antibiotic treatment did not differ between triage temperatures ≤36.0oC (66 min), 36.1-37.9oC (98.5 min), and ≥38.0oC (82 min) d (p=.7) Median time to fluid bolus differed between triage temperatures ≤36.0oC (40 min), 36.1-37.9oC (41.5 min), and ≥38.0oC (82 min) (p=.02). Patients with temperature ≤36.0oC had higher mortality (p=.02), less hospital and ICU free days (p=.05, p< .001), and higher organ dysfunction at 72hrs (p < .001).Conclusion(s): Time to fluid bolus administration differed by initial triage temperature, while time to antibiotic administration did not differ statistically. Additionally, there were worse outcomes in children with temp ≤36.0oC.
MCKENNA MURPHY CVMURPHY, MCKENNA CV.pdf
Table 2. Sepsis treatment-related outcomes by triage temperature