Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Red Zone — Recommended Initial Laboratory Testing for Septic Shock or Sepsis-Associated Organ Dysfunction

Blood

Blood Culture	Blood Culture Sources Blood Culture Clinical Pathway, PICU/PCU
Laboratory Studies	POC glucose Super gas with lactate CBC with differential Type and screen CRP Procalcitonin	BMP Magnesium Phosphorus Hepatic function panel Amylase, lipase PT/INR/PTT/fibrinogen

Urine

Urinalysis, Culture	Send a urinalysis any time a urine culture is sent
Urine HCG	Perform in ED or on Admission: All females ≥ 12 years, and females < 12 years that have experienced menarche

Consider the Following Additional Infectious Studies as Indicated Based on Patient Signs, Symptoms, History, Physical Exam

Respiratory

COVID	Given COVID-19 is now considered endemic, screening has become part of routine clinical practice.
Quad Screen (COVID/Flu/RSV PCR)	Send during winter respiratory viral season in patients with fever and lower respiratory tract symptoms.
Respiratory Viral Panel	Send if signs or symptoms of respiratory infection and specific viral diagnosis will change management (for example: immunocompromised patients, suspected nosocomial viral infection) Includes testing for corona 229E/OC43/HKU1/NL63
Respiratory Gram Stain, Culture	Send from an artificial airway only if a bacterial lower respiratory tract infection is suspected (for example: pneumonia on an X-ray) See Guidance for collection of tracheal aspirate cultures in the PICU/PCU.
Mycoplasma PCR	Consider sending in children > 5 in whom atypical pneumonia is suspected Pathway for Evaluation and Treatment of Child with Community-Acquired Pneumonia

CSF

CSF Profile, Gram Stain, Culture	Send if suspected encephalitis or meningitis Suspected Meningitis Clinical Pathway If suspected encephalitis, consider also sending save our specimen tube
HSV PCR	Send if suspected encephalitis or meningitis Suspected Meningitis Clinical Pathway

Stool

GI Bacterial Panel/stool Culture	This assay detects bacterial causes of community acquired diarrhea and should only be sent on patients who are hospitalized for < 48 hours

Skin

Wound Culture	As indicated if evidence of skin or soft tissue infections, cellulitis, abscess, etc.

Consider Inflammatory Conditions that May Manifest with Fever and Shock

Kawasaki Disease	See Kawasaki Disease Clinical Pathway for recommendations on laboratory testing

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Red Zone — Recommended Initial Laboratory Testing for Septic Shock or Sepsis-Associated Organ Dysfunction

Blood

Urine

Consider the Following Additional Infectious Studies as Indicated Based on Patient Signs, Symptoms, History, Physical Exam

Respiratory

CSF

Stool

Skin

Consider Inflammatory Conditions that May Manifest with Fever and Shock

Find a research study

Innovation and your child

Find research studies

Sepsis — Red Zone — Recommended Initial Laboratory Testing for Septic Shock or Sepsis-Associated Organ Dysfunction — Clinical Pathway: Emergency Department, Inpatient and PICU

Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Red Zone — Recommended Initial Laboratory Testing for Septic Shock or Sepsis-Associated Organ Dysfunction

Blood

Urine

Consider the Following Additional Infectious Studies as Indicated Based on Patient Signs, Symptoms, History, Physical Exam

Respiratory

CSF

Stool

Skin

Consider Inflammatory Conditions that May Manifest with Fever and Shock