Pathway for Evaluation/Treatment of Infants > 28 Days of Age and Children with Severe Sepsis

Identifying Children at Risk for Severe Sepsis / Septic Shock

Use  clinical suspicion to identify patients at risk for severe sepsis or septic shock. Patients with severe sepsis/septic shock have an infection which triggers an exaggerated immune response that causes inadequate tissue perfusion leading to organ failure. Hypotension is a late finding. Early recognition and goal directed therapy improve patient outcomes.

Use the following criteria to identify children with history, symptoms suggestive of infection and inadequate tissue perfusion:

Temperature Abnormality Fever > 38.5°C or < 36°C AND
Heart Rate Abnormality See table below AND


Mental Status Abnormality

Anxiety, restlessness, agitation, irritability, inappropriate crying
Drowsiness, confusion, lethargy, obtundation

Perfusion Abnormality Cool extremities, capillary refill > 3 seconds, diminished pulses, mottling   or
Flushed, warm extremities, bounding pulses, flash capillary refill

Patients with the following conditions are at HIGH RISK for severe sepsis:

For ED Patients:

Patients who meet the criteria above should be taken to the Resuscitation room to begin care.

Patients with some of the criteria in whom you are concerned about their clinical appearance should be prioritized for room placement with immediate notification of the Team Attending.

Age Tachycardia*
1 mo to 1 yr >180
>1 yr - 5 yrs >140
>5 yrs - 12 yrs >130
>12 yrs - <18 yrs >110

* >95th percentile

Remember, heart rate is affected by pain, anxiety, medications and hydration status.
Goldstein B. Pediatr Crit Care Med, 2005;6:2-8.