Pediatric SIRS Vital Signs:
Poor Predictor of Need for Critical Care

Retrospective study of children <18 years of age presenting to a pediatric
emergency department

Systemic inflammatory response syndrome vital signs identified only 23% of
children requiring ventilation or vasoactive agents.

SIRS vital signs were defined as abnormal temperature (<36°C or >38.5°C) plus
tachycardia or tachypnea (>2 mean standard deviations, adjusted for age).

Temperature-corrected heart rate (10 beats/minute subtracted for each 1°C over
38.5°C) which is still tachycardic is a useful indicator of sepsis

More important than identifying any one specific vital sign abnormality is tracking
vital signs after rehydration and antipyretic therapy

Consider sepsis in any child who has persistent tachypnea or tachycardia despite
temperature normalisation.
Reference Katherine Bakes, MD reviewing Scott HF et al. Acad Emerg Med 2015 Apr
WSHT Sepsis Screening tool
To be used for ALL unwell children presenting to the ED
Could this child have sepsis? Look for:
Tick
Recognise
Temperature <36 oC or >38.5oC
Value
o
Tachycardia (use age appropriate PEWS chart)
<1yr
1-5yrs
6-11yrs
12-16
16+
>180
>140
>120
>100
>90
Altered mental state:
Sleepy, floppy, lethargic or irritable
Mottled skin, or prolonged capillary refill time or ‘flash’ capillary refill time
/min
Suspected site/source:
If 3 criteria present:
THINK SEPSIS: This is a clinical emergency
Bleep Paediatric Team
If not: Sepsis unlikely, explore other causes : Time / Date :
C
Sign :
Respond
Paediatric Sepsis 6: Achieve the following within 1
hour - Refer to SORT sepsis pathway
(www.strs.nhs.uk or www.sort.nhs.uk)
1
2
3
4
5
Reassess
6
R1
R2
R3
Time
Sign
Give High Flow Oxygen
Record Blood Pressure and start urine collection (fresh nappy)
Obtain iv/io access
Take blood cultures, blood gas (include glucose & lactate)
Give Ceftriaxone 80mg/kg
Think: If neutropaenic, immunocompromised or a neonate, refer to
local guidance
Fluid Resuscitation if required
- 20ml/kg 0.9% Saline, reassess, repeat as needed
Within 1 hour of treatment
Persistent abnormal physiological parameters (HR, RR, CRT)
Lactate >2
Signs of fluid overload ( hepatomegaly, desaturations, crepitations)
Yes/No
If “Yes” to any of above (R1-3) - escalate care to
Paediatric and A&E Consultant, Anaesthetist
Also contact South Thames Retrieval Service (STRS) or SORT
Tel - (STRS): 020 7188 5000
If patient stabilised – admit to ward / HDU, review with at least
hourly observations for at least 4 hours