Appl Clin Inform 2021; 12(03): 469-478
DOI: 10.1055/s-0041-1730027
Research Article

Evaluation of a Sepsis Alert in the Pediatric Acute Care Setting

Karen DiValerio Gibbs
1   Texas Children's Hospital and the University of Texas Health Science Center, Houston Cizik School of Nursing, Houston, Texas, United States
Yan Shi
2   Texas Children's Hospital, Houston, Texas, United States
Nicole Sanders
2   Texas Children's Hospital, Houston, Texas, United States
Anthony Bodnar
2   Texas Children's Hospital, Houston, Texas, United States
Terri Brown
2   Texas Children's Hospital, Houston, Texas, United States
Mona D. Shah
3   Genentech, South San Francisco, California, United States
Lauren M. Hess
2   Texas Children's Hospital, Houston, Texas, United States
4   Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, Texas, United States
› Author Affiliations
Funding None.


Background Severe sepsis can cause significant morbidity and mortality in pediatric patients. Early recognition and treatment are vital to improving patient outcomes.

Objective The study aimed to evaluate the impact of a best practice alert in improving recognition of sepsis and timely treatment to improve mortality in the pediatric acute care setting.

Methods A multidisciplinary team adapted a sepsis alert from the emergency room setting to facilitate identification of sepsis in acute care pediatric inpatient areas. The sepsis alert included clinical decision support to aid in timely treatment, prompting the use of intravenous fluid boluses, and antibiotic administration. We compared sepsis-attributable mortality, time to fluid and antibiotic administration, proportion of patients who required transfer to a higher level of care, and antibiotic days for the year prior to the sepsis alert (2017) to the postimplementation phase (2019).

Results We had 79 cases of severe sepsis in 2017 and 154 cases in 2019. Of these, we found an absolute reduction in both 3-day sepsis-attributable mortality (2.53 vs. 0%) and 30-day mortality (3.8 vs. 1.3%) when comparing the pre- and postintervention groups. Though our analysis was underpowered due to small sample size, we also identified reductions in median time to fluid and antibiotic administration, proportion of patients who were transferred to the intensive care unit, and no observable increase in antibiotic days.

Conclusion Electronic sepsis alerts may assist in improving recognition of sepsis and support timely antibiotic and fluid administration in pediatric acute care settings.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by Baylor College of Medicine Institutional Review Board with a waiver of consent.

Publication History

Received: 28 December 2020

Accepted: 14 April 2021

Article published online:
26 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Balamuth F, Weiss SL, Neuman MI. et al. Pediatric severe sepsis in U.S. children's hospitals. Pediatr Crit Care Med 2014; 15 (09) 798-805
  • 2 Scott HF, Balamuth F, Paul RM. Sepsis bundles and mortality among pediatric patients. JAMA 2018; 320 (21) 2271
  • 3 Weiss SL, Fitzgerald JC, Pappachan J. et al; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 2015; 191 (10) 1147-1157
  • 4 Cruz AT, Williams EA, Graf JM. et al. Test characteristics of an automated age- and temperature-adjusted tachycardia alert in pediatric septic shock. Pediatr Emerg Care 2012; 28 (09) 889-894
  • 5 Lloyd JK, Ahrens EA, Clark D, Dachenhaus T, Nuss KE. Automating a manual sepsis screening tool in a pediatric emergency department. Appl Clin Inform 2018; 9 (04) 803-808
  • 6 Balamuth F, Alpern ER, Abbadessa MK. et al. Improving recognition of pediatric severe sepsis in the emergency department: contributions of a vital sign-based electronic alert and bedside clinician identification. Ann Emerg Med 2017; 70 (06) 759-768.e2
  • 7 Fesnak S, Abbadessa MK, Hayes K. et al. Sepsis in complex patients in the emergency department: time to recognition and therapy in pediatric patients with high-risk conditions. Pediatr Emerg Care 2020; 36 (02) 63-65
  • 8 Vidrine R, Zackoff M, Paff Z. et al. Improving timely recognition and treatment of sepsis in the pediatric ICU. Jt Comm J Qual Patient Saf 2020; 46 (05) 299-307
  • 9 Dewan M, Vidrine R, Zackoff M. et al. Design, implementation, and validation of a pediatric ICU sepsis prediction tool as clinical decision support. Appl Clin Inform 2020; 11 (02) 218-225
  • 10 Rolnick J, Downing NL, Shepard J. et al. Validation of test performance and clinical time zero for an electronic health record embedded severe sepsis alert. Appl Clin Inform 2016; 7 (02) 560-572
  • 11 Bradshaw C, Goodman I, Rosenberg R, Bandera C, Fierman A, Rudy B. Implementation of an inpatient pediatric sepsis identification pathway. Pediatrics 2016; 137 (03) e20144082
  • 12 Stinson HR, Viteri S, Koetter P. et al. Early experience with a novel strategy for assessment of sepsis risk: the shock huddle. Pediatr Qual Saf 2019; 4 (04) e197
  • 13 Center TCsHE-BO. Recognition and Initial Management of Septic Shock Evidence-Based Guideline. Accessed 2017 at:
  • 14 Larsen GY, Brilli R, Macias CG. et al; IMPROVING PEDIATRIC SEPSIS OUTCOMES COLLABORATIVE INVESTIGATORS. Development of a quality improvement learning collaborative to improve pediatric sepsis outcomes. Pediatrics 2021; 147 (01) e20201434
  • 15 Weiss SL, Peters MJ, Alhazzani W. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; 21 (02) 52-106
  • 16 Paul R, Brilli R, Macias C. et al. 32: Improving pediatric sepsis outcomes for all children together (IPSO FACTO): interim results. Crit Care Med 2021; 49 (01) 17
  • 17 Westra BL, Landman S, Yadav P, Steinbach M. Secondary analysis of an electronic surveillance system combined with multi-focal interventions for early detection of sepsis. Appl Clin Inform 2017; 8 (01) 47-66
  • 18 Berger T, Birnbaum A, Bijur P, Kuperman G, Gennis P. A computerized alert screening for severe sepsis in emergency department patients increases lactate testing but does not improve inpatient mortality. Appl Clin Inform 2010; 1 (04) 394-407
  • 19 Downing NL, Rolnick J, Poole SF. et al. Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation. BMJ Qual Saf 2019; 28 (09) 762-768
  • 20 Evans IVR, Phillips GS, Alpern ER. et al. Association between the new york sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA 2018; 320 (04) 358-367