International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics [PubMed Abstract] [Full Text PDF Download]. Pediatr Crit Care Med. 2005 Jan;6(1):2-8.
All that follows is from the above article:
Sepsis remains a major cause of morbidity and mortality among children (3–6). Sepsis-associated mortality in children decreased from 97% in 1966 (7) to 9% among infants in the early 1990s (8). A recent population-based study by Watson and colleagues (9) of U.S. childrenwith severe sepsis (bacterial or fungal infection with at least one acute organ dysfunction) reported 42,000 cases in 1995 with a mortality rate of 10.3%. Although
this represents a significant improvement over the past few decades, severe sepsis remains one of the leading causes of death in children, with 4,300 deaths annually (7% of all deaths among children) and estimated annual total costs of $1.97 billion (9).
The clinical variables used to define SIRS and organ dysfunction are greatly affected by the normal physiologic changes that occur as children age (22–26). Therefore, definitions of the sepsis continuum in children rely on age specific
norms of vital sign and laboratory data. We propose six clinically and physiologically
meaningful age groups for age-specific vital sign and laboratory variables
to meet SIRS criteria (Table 1): newborn, neonate, infant, toddler and preschool, school-aged child, adolescent, and young adult. In the table, newborns
are a separate age group from 0 to 7 days of life. Premature infants were not included
as their care occurs primarily in neonatal intensive care units. These age groups were determined by a combination of age-specific risks for invasive infections, age-specific antibiotic treatment recommendations, and developmental cardiorespiratory physiologic changes (22–29). When we use the term “children” in this document, we refer collectively
to all of these age groups.
The consensus definition for SIRS in children is listed in Table 2. The differences
from the adult definition are in bold. Although Bone et al.’s (1) basic recommendations
for the definition of SIRS are applicable to the pediatric population,
tachycardia and tachypnea are common presenting symptoms of many pediatric
disease processes. Therefore, the major difference in the definition of SIRS between
adults and children is that the diagnosis of pediatric SIRS requires that
temperature or leukocyte abnormalities be present (i.e., SIRS should not be diagnosed
if a pediatric patient exhibits only elevated heart and respiratory rates). In
addition, numeric values for each criterion need to be modified to account for
the different physiology of children. Finally, bradycardia may be a sign of SIRS
in the newborn age group but not in older children (in whom it is a nearterminal
event). Table 3 gives the age specific cutoffs for each criterion. These values were chosen after careful review of the medical literature and the cited references.
As no evidence-based values for abnormal vital signs and laboratory values
were found, the values cited are based on expert opinion from the cited references.
Fever may also be documented by a reliable source at home if within 4 hrs of presentation to the hospital or physician’s office. Fever may be due to overbundling in small infants (38). If overbundling is suspected, the child should be unbundled and the temperatureretaken in 15–30 mins (37). Hypothermia (i.e., 36°C) may also indicate
serious infection, especially in infants (38, 40, 41).
