Another Wee "Sepsis Screening Is Garbage" Article

Oh, horrors, we sent home so many "high-risk" sepsis children!

All clinicians hate sepsis screening tools. See: SEP-1.

Turns out, in the U.K., some hate their NICE sepsis criteria just as much.

This is a very brief secondary analysis from the CAP-IT trial. The purpose of CAP-IT was to evaluate the proper dose and length of antibiotic prescribing for children with community-acquired pneumonia. As a happy accident, as occurs in many trials, a host of extra clinical data was gathered along with the information required for the primary outcome.

In this analysis, the authors looked to see if the children enrolled met any “high-risk” NICE criteria for sepsis, the sorts of criteria enshrined in guidelines recommending early administration of a broad-spectrum antimicrobial, admission, and supportive care. The key table in their results is here:

Here we see the vast majority of children enrolled in this trial, that is, randomized to different doses and lengths of antimicrobial therapy, were discharged from the pediatric emergency department rather than an inpatient ward. At the same time, both amusingly and tragically, over half those patients discharged directly from the emergency department actually met at least one high-risk NICE sepsis screening criteria.

These criteria obviously do not have reliable clinical utility when, as you can see, these “high-risk” patients are actually safe to discharge on oral amoxicillin.