If you have never heard of sepsis before, count yourself lucky. September is Sepsis Awareness Month, and the World Health Organization has recently published its first global report on the deadly condition. The report finds that there are nearly 50 million cases of sepsis worldwide each year, and is the cause of 20% of all deaths worldwide. Most of these deaths occur in “vulnerable” populations, including newborns, people with few resources, and the elderly. And, sadly, sepsis misdiagnosis in children is a very real problem.
Unfortunately, almost half of these millions of cases occur in children. WHO reports this number as nearly 3 million worldwide deaths, while another reputable source pegs the number at 7.5 million deaths. Tragically, “most of which could be prevented through early diagnosis and appropriate clinical management.”
In the United States, approximately 72,000 children are hospitalized with sepsis, with 18,000 children dying every year.
Sepsis misdiagnosis in children happens regularly for different reasons
One big reason that cuts across all ages is the difficulty in defining it. The most recent definition of sepsis (2016) is referred to as SEPSIS-3. However, clinicians may be working from previous definitions, or institutions may be slow to enact changes to protocols aimed at better diagnosing the disease.
While a similar Taskforce for Pediatric Sepsis has been created, no results or consensus definitions have thus far been published.
Further, adult criteria don’t directly apply to children. For example, the vital sign values are different, and even different within the pediatric population by age. Consider that, for adults, one vital sign clinicians should consider is respiratory rate (RR). For an adult, if the RR is over 22 that indicates possible sepsis.
For children, it is different, and sometimes very different. For neonates (birth to 28 days), the number is 50, while kids age 1-12 months the number is 34. But for teenagers, the number is actually lower than for adults: it is 14.
This can be problematic because 85% of children with undiagnosed sepsis end up in a community based or adult ER where providers are not as experienced diagnosing and treating them.
Delays in diagnosing or misdiagnosing sepsis in children can also be difficult for other reasons, such as communication. A detailed history can be difficult to get from kids – most young children can’t explain what they are feeling (and this gets worse as kids are younger). Without vigilance – and keeping up to date on the evolving standard of care in diagnosing and treating children with sepsis – kids will continue to go undiagnosed, or diagnosed too late to survive this deadly disease.
