pediatric sepsis
Well, I knew that it would not be long before a statement was made regarding the 'new sepsis definition' and applying to pediatrics. We had a discussion just last week in our PICU leadership meeting regarding the new definition and it's use in peds. The short-comings of this definition were explored. Today I received an email from one of the critical care attendings regarding a SCCM podcast that he attended. This is his synopsis of that podcast;
'in the latest SCCM podcast which came out 2 days ago they were discussing the significance of the new definitions of sepsis. The speaker, who was the head of the Sepsis 3 task force pointed out that the new definitions are not applicable in pediatrics. He gave 2 reasons for that
1) The new sepsis criteria as they are composed are based on SOFA score, which is a severity score not validated for pediatrics
2) What they were trying to accomplish at sepsis 3 was to identify those people who have sepsis and septic shock reflecting a mortality of 10% and 35% respectively. So they determined after going through a large database of patients who are were truly septic that sepsis had a mortality of 10% and septic shock 35%, and then they went back and looked for the “common denominator†of symptoms that were present in patients that fit this criteria and had this mortality. So they found that the quick-sofa tool that they developed for non-ICU patients had a correlation of 0.84 with patients who were truly septic. However, since the mortality rate in pediatric sepsis is not the same as adult sepsis, the process that they used would not apply to pediatric patients'
This information is vital to those of us working in pediatric hospitals with attendings who were not sure which direction to go
Val Bica
'in the latest SCCM podcast which came out 2 days ago they were discussing the significance of the new definitions of sepsis. The speaker, who was the head of the Sepsis 3 task force pointed out that the new definitions are not applicable in pediatrics. He gave 2 reasons for that
1) The new sepsis criteria as they are composed are based on SOFA score, which is a severity score not validated for pediatrics
2) What they were trying to accomplish at sepsis 3 was to identify those people who have sepsis and septic shock reflecting a mortality of 10% and 35% respectively. So they determined after going through a large database of patients who are were truly septic that sepsis had a mortality of 10% and septic shock 35%, and then they went back and looked for the “common denominator†of symptoms that were present in patients that fit this criteria and had this mortality. So they found that the quick-sofa tool that they developed for non-ICU patients had a correlation of 0.84 with patients who were truly septic. However, since the mortality rate in pediatric sepsis is not the same as adult sepsis, the process that they used would not apply to pediatric patients'
This information is vital to those of us working in pediatric hospitals with attendings who were not sure which direction to go
Val Bica
Comments
-----Original Message-----
From: Pediatric CDI Talk [mailto:pediatric_cdi_talk@hcprotalk.com]
Sent: Tuesday, April 19, 2016 12:00 AM
To: Dearborn, Linda R
Subject: re:[pediatric_cdi_talk] pediatric sepsis
Folks should be familiar with this:
http://emedicine.medscape.com/article/2072410-overview
As with the SOFA criteria, they don't use the proper words to delineate organ failures, but use observations and lab results as a substitute to acute renal failure and metabolic encephalopathy and respirator failure, etc; but, if you can plug in appropriate pediatric criteria, you'll be virtually parallel with the adult model.
Check it out.
Dr. G.
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from what I have found it seems that you have to be a member of sccm to have access to the podcasts. are any of your critical care docs members?
also on another note; found an article that quotes AHIMA recommendations on the proposed changes to ICD 10 for Oct 1 2016. I know you had questions about growing rods and psf kids in the past, found this in the article;
Insertion of Spinal Bracing and Distraction System
AHIMA supports option 2, creation of a new device value, Internal Fixation Device, Magnetically Controlled, for the vertebral body part values, in tables 0PS and 0QS.
We recommend using existing codes in table 0PW and 0QW to capture revision of magnetically controlled growth rods. Since the purpose of the C&M proposal is to identify a specific type of growth rod in the event this technology is approved for a new technology add-on payment, we believe that creating unique codes for this device for the initial insertion and using existing codes for subsequent adjustments of the device is appropriate.