Background: Paediatric sepsis remains a significant cause of morbidity and mortality worldwide[i]. Identification of sepsis in children can be challenging prehospitally, due to its variable presentation and paucity of validated pre-hospital diagnostic tools and resources[ii]. Often the first point of contact in the patient journey, paramedics hold an important role in initiating and escalating care pathways². Further, more than 50% of paediatric deaths due to sepsis occur in the first 24 hours, highlighting the importance of early recognition and management[iii]. Understanding current practice patterns and challenges could inform future research and education strategies. 

Objectives: our aim was to describe the practice patterns of paramedics working in Northern Territory, Australia, in the recognition and management of sepsis in paediatric patients. Further, we aimed to identify perceived priorities for future research and education. 

Method: we conducted a cross-sectional, internet-based survey of paramedics working for St John Ambulance in the Northern Territory (NT), Australia. The survey was externally validated, and distributed using a via email using a modified Dillman Methodology. Rank scores were utilised for Likert frequency values. Results were analysed using descriptive statistics. 

Results: Patient age was negatively correlated with clinician confidence in their ability to identify sepsis. Overall patient appearance, hygiene, parental concern, and overcrowding (RS = 4.55, 3.78, 3.9, 3.6) were the highest ranked scene features used when identifying sepsis; immunocompromised status, deterioration despite prior treatment and re-presentation to medical services (RS = 4.6, 4.48, 4.1) were the most highly ranked features of patient history in identifying sepsis. Altered level of consciousness, tachypnoea, and tachycardia (RS = 4.67, 4.67, 4.5) were the highest ranked clinical signs. Validation of prehospital tools and defined pre-hospital treatment pathway guidelines were of highest priority to respondents for future research and professional education. Conclusions: While there exists some practice variability, paramedics working for St John Ambulance rely heavily on clinical signs for identifying sepsis in the prehospital environment. Improvements in recognition through standardized diagnostic tools and streamlining treatment pathways were perceived as future priorities for professional education and research. Our results provide an important guide for future research and pre-hospital education in paediatric sepsis. 

References:
[i] Weiss, S. L., Fitzgerald, J. C., Pappachan, J., Wheeler, D., Jaramillo-Bustamante, J. C., Salloo, A., Singhi, S. C., Erickson, S., Roy, J. A., Bush, J. L., Nadkarni, V. M., Thomas, N. J., & Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2015). Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. American journal of respiratory and critical care medicine, 191(10), 1147–1157. https://doi.org/10.1164/rccm.201412-2323OC

[ii] Harley, A., Schlapbach, L. J., Johnston, A. N. B., & Massey, D. (2022). Challenges in the recognition and management of paediatric sepsis - The journey. Australasian emergency care, 25(1), 23–29. https://doi.org/10.1016/j.auec.2021.03.006

[iii] Schlapbach, L. J., MacLaren, G., Festa, M., Alexander, J., Erickson, S., Beca, J., Slater, A., Schibler, A., Pilcher, D., Millar, J., Straney, L., & Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group (2017). Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive care medicine, 43(8), 1085–1096. https://doi.org/10.1007/s00134-017-4701-8)