Research and Activities

If you have any questions about the Pediatric Sepsis Program, please contact us by phone at 215-590-5505 or via our online contact form.

Clinical pathways

Active quality improvement projects, research, and activities

Title: Organ Dysfunction Based Outcomes in a Hospital-wide Sepsis Quality Improvement Program
Project lead: Julie Fitzgerald, MD, PhD; Fran Balamuth, MD, PhD, MSCE; Scott Weiss, MD, MSCE; Christian Minnich and others

Title: Racial Disparities in Sepsis Recognition
Project lead: Jenny Raman, Tiffani Johnson, Lena Winestone, MD; Fran Balamuth, MD, PhD, MSCE

Title: Sepsis Alert Performance in Children with High-risk Conditions
Project lead: Sarah Fesnak, Fran Balamuth, MD, PhD, MSCE

Title: Improving ED Sepsis Alert/Huddle Process
Project lead: Ellie Souganidis, Fran Balamuth, MD, PhD, MSCE

Title: Sepsis Screening in Hospitalized Pediatric Patients
Project lead: Ms. Sharon Kaminski, Scott Weiss, MD, MSCE
Funding: CHOP OCQI
Objective: To develop and implement a highly sensitive and reasonably specific electronic health record based alert to guide clinicians in the early recognition of sepsis for hospitalized patients

Title: Sepsis Registry and Adjudication
Project lead: Julie Fitzgerald, MD, PhD
Funding: CHOP Department of Pediatrics Chair’s Initiative
Objective: To review and confirm the diagnosis of sepsis in cases identified by sepsis screening to ensure appropriate cases are identified and quality metrics are tracking in patients with true sepsis.

Title: Long-term Follow-up of Pediatric Sepsis Survivors
Project lead: Scott Weiss, MD, MSCE
Funding: CHOP Department of Pediatrics Chair’s Initiative
Objective: To develop a process or clinic dedicated to assess long-term morbidity in pediatric sepsis survivors

Title: Sepsis Screening in a Community Pediatric Emergency Department
Project lead: Ronald Marchese, MD; Fran Balamuth, MD, PhD, MSCE
Funding: CHOP Department of Pediatrics Chair’s Initiative
Objective: To translate the CHOP ED sepsis screen to a community site

Title: Sepsis Screening in the Pediatric Emergency Department
Principal investigator: Fran Balamuth, MD, PhD, MSCE
Co-investigator: Ellie Souganidis, MD
Funding: CHOP Division of Emergency Medicine
Objective: Developed and implemented a vital sign based screen for sepsis in the Emergency Department which decreased missed sepsis cases by 76 percent. We are currently working to further refine the alert by evaluating cases missed under the screening system.

Title: Racial Disparities in Sepsis Screening and Treatment in the Emergency Department
Principal investigator: Ms. Jenny Raman, Tiffani Johnson MD, MS; Lena Winestone, MD; Fran Balamuth MD, PhD, MSCE
Funding: CHOP
Objective: To evaluate racial disparities in sepsis alert performance as well as sepsis care in the Emergency Department

Basic/translational scientific research

Title: Mitochondrial Dysfunction in Pediatric Sepsis
Principal investigator: Scott L. Weiss, MD, MSCE
Funding: NIH
Objective: Test noninvasive measures of mitochondrial dysfunction using circulating mononuclear blood cells and plasma to identify subsets of children with sepsis and organ failure who could be targeted for mitochondrial-based therapies

Title: Role of the Intestinal Microbiome in Mitochondrial-induced Immune Dysregulation in Pediatric Sepsis
Principal Investigator: Scott L. Weiss, MD, MSCE
Funding: Society of Critical Care Medicine
Objective: Test the overall hypothesis that sepsis impacts mitochondrial-induced immune dysregulation via alterations in short-chain fatty acids derived from an abnormal intestinal microbiome

Title: PRoMPT BOLUS
Principal Investigator: Fran Balamuth, MD, PhD, MSCE; Scott L. Weiss, MD, MSCE
Funding: NIH/CHOP
Objective: Pragmatic randomized clinical trial to test the comparative effectiveness of different crystalloid fluids for resuscitation of pediatric septic shock

Title: RNA Expression Profiling and Pediatric Sepsis Recognition
Principal investigator: Fran Balamuth, MD, PhD, MSCE
Funding: NIH
Objective: To determine the association between peripheral blood RNA expression profiles at sepsis diagnosis and both organ dysfunction at hospital day 2 and source pathogen

Title: Mitochondrial Dysfunction in EBV-Transformed Lymphoblasts and Induced Pluripotent-derived human Stem Cells (iPSCs) in Pediatric Sepsis
Principal investigatorScott L. Weiss, MD, MSCE
Funding: NIH
Objective: To model the mitochondrial-targeted effects of sepsis on immune or organ cells

Title: Biomarkers of Endothelial Dysfunction in Critically Ill Children with Sepsis and Acute Respiratory Distress Syndrome
Principal investigatorJane Whitney, MD
Funding: CHOP
Objective: To determine if biomarkers linked to endothelial dysfunction are associated with development of acute respiratory distress syndrome (ARDS) in children with sepsis

Clinical research

Title: CMV Reactivation in Pediatric Sepsis    
Principal investigator: MoonJoo Han, MD
Funding: CHOP Foerderer Award for Excellence in Research
Objective: To determine the cumulative incidence and clinical significance of CMV viremia and CMV reactivation in pediatric severe sepsis

Title: Urine Biomarkers to Detect and Predict Acute Kidney Injury in Pediatric Septic Shock  
Principal investigator: Julie Fitzgerald, MD, PhD, MSCE  
Funding: CHOP Division of Critical Care Medicine
Objective: To identify urine biomarkers that can be measured noninvasively and are sensitive and specific for predicting acute kidney injury in children with septic shock

Title: Severe Sepsis and Septic Shock in Immunocompromised Children: Risk Factors for PICU Mortality   
Principal Investigator: Julie Fitzgerald, MD, PhD, MSCE; Robert B. Lindell, MD  
Funding: CHOP Division of Critical Care Medicine
Objective: To identify risk factors for PICU mortality in immunocompromised children with severe sepsis or septic shock using a nation multicenter PICU database

Title: Clinical prediction modeling for organ dysfunction in suspected pediatric sepsis
Principal investigator: Fran Balamuth MD, PhD, MSCE; Hanna Gu, MD
Funding: CHOP
Objective: To use machine learning methods to identify clinical and laboratory predictors of organ dysfunction in the first three hospital days for children presenting to the ED with suspected sepsis

Research publications

2017

Lin JC, Spinella PC, Fitzgerald JC, Tucci M, Bush JL, Nadkarni VM, Thomas NJ, Weiss SL for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. New or Progressive Multiple Organ Dysfunction Syndrome (NPMODS) in Pediatric Severe Sepsis: A Sepsis Phenotype with Higher Morbidity and Mortality. Pediatr Crit Care Med. 2017 Jan;18(1):8-16.

Weiss SL, Keele L, Balamuth F, Vendetti N, Ross R, Fitzgerald JC, Gerber JS. Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study. J Pediatr. 2017 Mar;182:304-310.e10.

Downes KJ, Weiss SL, Klieger SB, Fitzgerald JC, Balamuth F, Kubis S, Tolomeo P, Bilker W, Han X, Nachamkin I, Garrigan C, Han J, Lautenbach E. Gerber JS, Coffin S for The CDC Prevention Epicenters Program. A Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study. J Pediatric Infect Dis Soc. 2017 Jun 1;6(2):134-141.

Han M, Fitzgerald JC, Balamuth F, Keele L, Alpern ER, Lavelle J, Chilutti M, Grundmeier RW, Nadkarni VM, Thomas NJ, Weiss SL. Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis. Shock. 2017 Jul;48(1):29-35.

Weiss SL, Asaro LA, Flori HR, Allen GL, Wypij D, Curley MAQ. Multiple Organ Dysfunction in Children Mechanically Ventilated for Acute Respiratory Failure. Pediatr Crit Care Med. 2017 Apr;18(4):319-329.

Balamuth F, Alpern ER, Funari MK, Hayes K, Schast A, Lavelle J, Fitzgerald JC, Weiss SL, Zorc JJ. 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 Jun 2. pii: S0196-0644(17)30315-3.

Weiss SL, Balamuth F, Hensley J, Fitzgerald JC, Bush J, Nadkarni VM, Thomas NJ, Hall M, Muszynski J. The Epidemiology of Hospital Death Following Pediatric Severe Sepsis: When, Why, and How Children With Sepsis Die. Pediatr Crit Care Med. 2017 May 25.

2016

Klieger SB, Fitzgerald JC, Weiss SL, Balamuth F, Teszner E, Sammons JS, Coffin SE. Pediatric Severe Sepsis/Septic Shock Associated with Healthcare-Associated Infections. Infect Control Hosp Epidemiol. 2016 Apr;37(4):483-5.

Giuliano JS, Jr, Markovitz BP, Brierley J, Levin R, Williams G,  Lum LC, Dorofaeff T, Cruces P, Bush JL, Keele L, Nadkarni VM, Thomas NJ, Fitzgerald JC, Weiss SL for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs.  Pediatr Crit Care Med. 2016 Jun;17(6):522-30.

Balamuth F, Weiss SL, Fitzgerald JC, Hayes K, Centkowski S, Chilutti M, Grundmeier R, Lavelle J, Alpern ER. Protocolized Treatment Is Associated With Decreased Organ Dysfunction in Pediatric Severe Sepsis. Pediatr Crit Care Med. 2016 Sep;17(9):817-22.

Lautz AJ, Dziorny AC, Denson AR, O’Connor KA, Chilutti MR, Ross RK, Gerber JS, Weiss SL. Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit. J Pediatr. 2016 Dec;179:74-81.e2.

Fitzgerald JC, Basu R, Akcan-Arikan A, Izquierdo LM, Pineres Olave BE, Hassinger AB, Szczepanski M, Deep A, Williams D, Sapru A, Roy JA, Nadkarni VM, Thomas NJ, Weiss SL, Furth S for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) NetworkAcute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability. Crit Care Med. 2016 Dec;44(12):2241-2250.

2015

Weiss SL, Selak MA, Tuluc F, Perales-Villarroel JP, Nadkarni VM, Deutschman CS, Becker, LB. Mitochondrial Dysfunction in Peripheral Mononuclear Cells in Pediatric Septic Shock. Pediatr Crit Care Med. 2015 Jan;16(1):e4-e12.

Weiss SL*, Fitzgerald JC*, PappacHan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, Singhi SC, Erickson S, Roy JA, Bush JL, Nadkarni VM, Thomas NJ for the 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 (SPROUT) Study. Am J Respir Crit Care Med. 2015 May 15;191(10):1147-57.  (*contributed equally)

Balamuth F, Alpern ER, Weiss SL, Grundmeier R, Chilutti M, Fitzgerald JC, Hayes K, Bilker W, Lautenbach E. Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department. Acad Emerg Med. 2015 Nov;22(11):1298-306.

Weiss SL, Fitzgerald JC, Maffei F, Kane JM, Rodriguez-Nunez A, Hsing DD, Franzon D, Ying Kee S, Bush JL, Roy JA, Thomas, NJ, Nadkarnin VM for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Discordant Identification of Pediatric Severe Sepsis by Research and Clinical Definitions in the SPROUT International Point Prevalence Study. Crit Care. 2015 Sep 16;19:325

Balamuth F, Weiss SL, Hall M, Neuman MI, Scott H, Brady PW, Paul R, Farris RWD, McClead R, Centkowski S, Baumer S, Weiser J, Hayes K, Shah SS, Alpern ER. Identifying pediatric severe sepsis and septic shock: accuracy of diagnosis codes. J Pediatr. 2015 Dec;167(6):1295-300.e4.

2014

Weiss SL, Fitzgerald JC, Faustino EV, Festa MS, Fink EL, Jouvet P, Bush JL, Kissoon N, Marshall J, Nadkarni VM, Thomas NJ. Understanding the Global Epidemiology of Pediatric Critical Illness: The Power, Pitfalls, and Practicalities of Point Prevalence Studies. Pediatr Crit Care Med. 2014 Sep;15(7):660-666.

Weiss SL, Fitzgerald JC, Balamuth F, Alpern ER, Lavelle J, Chilutti M, Grundmeier R, Nadkarni VM, Thomas NJ. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Crit Care Med. 2014 Nov;42(11):2409-17.

Balamuth F, Weiss SL, Neuman MI, Scott H, Brady PW, Paul R, Farris RWD, McClead R, Hayes K, Gaieski D, Hall M, Shah SS, Alpern ER. Pediatric Severe Sepsis in US Children's Hospitals. Pediatr Crit Care Med. 2014 Nov;15(9):798-805.

Scientific presentations

2017

Weiss SL, Zhang D, Graham K, Deutschman CS, Kilbaugh T, McGowan F, Becker L,  Wallace D. Reduced Mitochondrial Mass Underlays Decreased Respiration in Septic Immune Cells. Star Research Presentation at the 46th Critical Care Congress, January 22-25, 2017, Honolulu, Hawaii.

Weiss SL, Balamuth F, Fitzgerald J, Hensley J, Bush J, Thomas N, Hall M, Muszynski J. Epidemiology of Death Following Pediatric Sepsis: When, Why, and How Septic Kids Die. Research Snapshot Presentation at the 46th Critical Care Congress, January 22-25, 2017, Honolulu, Hawaii.

Gu H, Keele L, Hayes K, Fitzgerald J, Weiss SL, Balamuth F. Machine Learning Predictive Modeling for Organ Dysfunction In Children with Suspected Sepsis in the Emergency Department. Oral presentation at the American Academy of Pediatrics Annual Meeting, September 2017, Chicago, Illinois.

Downes KJ, Schriver E, Russo M, Weiss SL, Fitzgerald JC, Balamuth F, Tolomeo P, Bilker WB, Han JH, Lautenbach E, Coffin SE, Gerber JS for the CDC Prevention Epicenters Program. Implementation of a Pragmatic Biomarker-driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study. Poster presentation at the IDWeek 2017 Conference, Oct 4-8, 2017, San Diego, CA.

2016

Signoff J, Fitzgerald F, Teachey D, Balamuth F, Weiss SL. Hypofibrinogenemia Is Associated with Poor Outcome and Secondary HLH in Pediatric Severe Sepsis. Critical Care Medicine. 2015;43(12) Suppl:A260 [Research Snapshot Presentation at the 45th Critical Care Congress, February 21-24, 2016, Orlando, Florida].

Han M, Fitzgerald J, Balamuth F, Chilutti M, Grundmeier R, Nadkarni V, Thomas N, Weiss SL. Hourly Delays to Antimicrobial Therapy Do Not Increase One-year Mortality in Pediatric Severe Sepsis. Critical Care Medicine. 2015;43(12) Suppl:A272-273. [Research Snapshot Presentation at the 45th Critical Care Congress, February 21-24, 2016, Orlando, Florida].

Abaya R, Weiss SL, Fitzgerald JC, Balamuth F. Utility of Procalcitonin to Predict Intensive Care Unit Admission and Identify Bacterial Illness in the ED Resuscitation of Pediatric Sepsis. Poster presentation, Pediatric Academic Societies’ Annual Meeting, April 30-May 3, 2016, Baltimore, Maryland.

Ballantine A, DiTaranto S, Roberts K, Balamuth F, Weiss SL, Fitzgerald J, Hadley S, Minich C, Rigby V, Keren R. Improving Response to Suspected Sepsis: Results of a Hospital-wide Quality Improvement Initiative. Poster presentation, American Academy of Pediatrics National Conference & Exhibition, October 22-25, 2016, San Francisco, CA.

2015

Balamuth F, Caplan I, Scott H, Weiss SL, Fitzgerald J, Kubis S, Chilutti M, Grundmeier R, Alpern ER. Increased Risk of One-year All-cause Mortality after Pediatric Severe Sepsis. Critical Care Medicine. 2014;42(12) Suppl:A1606 [Poster Presentation at the 44th Critical Care Congress, January 2015, Phoenix, Arizona].

Klieger SB, Fitzgerald JC, Weiss SL, Balamuth F, Teszner E, Sammons JS & Coffin SE. Pediatric Severe Sepsis/Septic Shock Attributable to Healthcare-associated Infections. The Society for Healthcare Epidemiology of America (SHEA) annual meeting. May 2015, Orlando, Florida.

Dziorny A, Lautz A, Densen A, O’Connor K, Weiss SL. Procalcitonin for Early Recognition of Severe Bacterial Infections in the Pediatric Intensive Care Unit. Platform presentation, Pediatric Academic Societies’ Annual Meeting, April 25-28, 2015, San Diego, California.

Balamuth F, Funari MK, Hayes K, Schast A, Lavelle J, Fitzgerald JC, Weiss SL, Alpern ER, Zorc, JJ. Improved Emergency Department Recognition of Pediatric Severe Sepsis/Septic Shock with an Electronic Alert. Platform presentation, Pediatric Academic Societies’ Annual Meeting, April 25-28, 2015, San Diego, California.

Balamuth F, Hayes K, Centkowski S, Gagel A, Fitzgerald JC, Weiss SL, Chilutti M, Grundmeier R, Lavelle J, Alpern ER. Decreased Organ Failure in Pediatric Sepsis Treated According to a Bundled Treatment Guideline. Poster presentation, Pediatric Academic Societies’ Annual Meeting, April 25-28, 2015, San Diego, California.

Downes KJ, Weiss SL, Klieger SB, Fitzgerald JC, Balamuth F, Kubis S, Tolomeo P, Bilker W, Han X, Nachamkin I, Garrigan C, Han J, Lautenbach E. Gerber JS, Coffin S for The CDC Prevention Epicenters Program. Developing a Biomarker-driven Algorithm to Improve Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study. Oral presentation, IDWeek, October 9, 2015, San Diego, CA.

2014

Balamuth F, Weiss SL, Fitzgerald JC, Hayes K, Chilutti M, Grundmeier R, Myers S, Lautenbach E, Alpern ER. Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department. Platform Presentation at the Pediatric Academic Societies Annual Meeting, May 2014, Vancouver, BC, Canada.

2013

Weiss SL, Fitzgerald J, Blamuth F, Alpern ER, Lavelle J, Chilutti M, Grundmeier R, Thomas N, Nadkarni VM. Surviving Sepsis in the Hospital: Location, Location, Location! Crit Care Med. 2012;40(12) Suppl:A480. [Poster presented at 42nd Critical Care Congress, Jan 19-23, 2013, San Juan, PR]

Balamuth F, Woodford A, Weiss SL, Fitzgerald J, Chilutti M, Grundmeier R, Wein JN. Fesnak S, Lavelle J, Alpern ER. There’s an App for That: An Electronic Health Record Sepsis Registry and Clinical Protocol to Improve Quality of Care. Platform presentation. Pediatric Academic Societies’ Annual Meeting, May 2013, Washington, DC.

Grundmeier RW, Chilutti MR, Ostapenko S, Woodford AL, Wein JN, Czaplicki DJ, Schilling DM, Fitzgerald JC, Weiss SL, Balamuth FB, Alpern ER, Lavelle JM. Defining the Gold Standard: Manual Abstraction versus Automated Data Extraction for a Complex Sepsis Registry. Platform Presentation: 6th Annual Mid-Atlantic Healthcare Informatics Symposium, April 26, 2013, Philadelphia, PA.

Woodford AL, Weiss SL, Fitzgerald JC, Chilutti M, Grundmeier R, Lavelle J, Alpern ER, Balamuth F. Expedited Care and Reduced Length of Stay in Critically Ill Pediatric Patients with Sepsis Treated Using a Clinical Pathway and Electronic Order Set in the Emergency Department. Platform Presentation at American Academy of Pediatrics National Conference, October 2013, Orlando, FL.

Balamuth F, Weiss SL, Scott H, Paul R, Neuman M, Ferris R, McClead R, Hall M, Shah S, Alpern ER. For the PHIS Sepsis Research Working Group. Choice of Coding Strategies Directly Impact Estimates of the Epidemiology and Outcomes of Pediatric Severe Sepsis. Poster Presentation at American Academy of Pediatrics National Conference, October 2013, Orlando, FL.

Weiss SL, Villarroel JP, Selak MA, Tuluc F, Deutschman CS, Nadkarni VM, Becker LB. Mitochondrial Dysfunction in Circulating Immune Cells in Pediatric Septic Shock. Crit Care Med. 2013;41(12) Suppl:A17 [Oral Presentation at the 43rd Critical Care Congress, San Francisco, CA].

Fitzgerald JC, Weiss SL, Nadkarni VM, Bush J, Thomas NJ, for the SPROUT and PALISI Network Investigators. Global Epidemiology and Outcomes of Pediatric Severe Sepsis – The Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study. Crit Care Med. 2013;41(12) Suppl: A137 [Poster Presentation at the 43rd Critical Care Congress, San Francisco, CA].