DEVELOPING A RAPID ASSESSMENT AND INTERVENTION PROTOCOL FOR PEDIATRIC SEPSIS IN THE EMERGENCY DEPARTMENT: INTEGRATION OF CHEMICAL PATHOLOGY BIOMARKERS AND POINT-OF-CARE TESTING
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Keywords
Pediatric Sepsis, Chemical Pathology Biomarkers, morbidity and mortality
Abstract
Background: Pediatric sepsis is one of the major causes of morbidity and mortality across the globe, especially in resource-suboptimal emergency units where early identification is one of the factors that are associated with adverse outcomes. Biochemical markers can be used to identify a condition at an early stage and facilitate intervention.
Objective: To develop and evaluate a rapid assessment and intervention protocol integrating chemical pathology biomarkers and point-of-care testing (POCT) for pediatric sepsis in the emergency department.
Methods: This observational research was done in the Pediatric Emergency Department of Lady Reading Hospital, Peshawar, between January and June 2025. Sixty two of these children were 1 month to 12 years old. The rapid screening consisted of clinical evaluation, point-of-care lactate, and venous blood gas evaluation and laboratory C-reactive protein (CRP) and procalcitonin (PCT). The compliance with sepsis bundle, time to intervention indicators and clinical outcomes were documented. Comparisons were made between shock vs non-shock patients and lactate <2 mmol/L vs ≥2 mmol/L groups.
Results: Shock was present in 31.9% of patients. Mean lactate levels were significantly higher in shock patients (4.8 ± 1.9 mmol/L) compared to non-shock patients (2.1 ± 0.9 mmol/L; p < 0.001). ICU admission was significantly more frequent among children with lactate ≥2 mmol/L (42.9% vs 10.0%; p = 0.003). Antibiotics were administered within 60 minutes in 80.6% of cases. Overall mortality was 8.3%, primarily among patients with persistent hyperlactatemia.
Conclusion: Integration of POCT lactate and inflammatory biomarkers into a rapid pediatric sepsis protocol improved early risk stratification and was strongly associated with clinical severity and outcomes. Biomarker-guided management may enhance emergency sepsis care in high-burden settings.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Ali Sebtain
Assistant Professor, Department of Emergency Medicine, Lady Reading Hospital, Peshawar, Pakistan
Sana Saeed
Trust Doctor, Department of Medicine, Peterborough City Hospital, Peterborough, England
Jalil Khan
Assisstant Professor, Department of Pediatrics, Bannu Medical Collage, Bannu/Khalifa Gul Nawaz Hospital, Bannu, Pakistan
Bubrak Amin
Neonatal Registrar, Department of Neonatology, University Hospital Galway, Ireland
Hamayun Mumtaz
Assistant Professor, Department of Pathology, Poonch Medical College Rawalakot, AJK, Pakistan
Muhammad Ibrahim
Assistant Professor, Department of Pediatric, Gomal Medical College, MTI DI Khan, Pakistan
