128 - Improving Pediatric Sepsis Outcomes: The Role of Prehospital Sepsis Alert Criteria in Early Intervention and Outcomes

Publication Number: 128.5191

Jack M. Christian, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Nicolas A. Wyhs, Johns Hopkins University School of Medicine, San Diego, CA, United States; Jennifer F. Anders, Johns Hopkins Children's Center, BALTIMORE, MD, United States

Background: Mortality in pediatric sepsis increases with delay in recognition and treatment, including early fluid resuscitation and antibiotics. Given the importance of early recognition, the Maryland Institute for Emergency Medical Services (EMS) System implemented a Pediatric Sepsis Rule-In Criteria protocol to promote prehospital identification and treatment of sepsis.

Objective: We sought to evaluate the impact of this novel prehospital pediatric sepsis identification tool on patient outcomes.

Design/Methods: We conducted a retrospective cohort study of all patients admitted to Johns Hopkins Hospital (JHH) through the pediatric emergency department (PED) with a sepsis admitting diagnosis from 07/01/2016 to 12/31/2023. Protocol-identified subjects were patients transported by Maryland EMS to the JHH PED with either pre-hospital PED notification of sepsis (“Sepsis Alert”) or a primary or secondary impression of “sepsis” listed in the EMS chart. Outcomes for these subjects were compared to age-matched patients presenting to the JHH PED by non-ambulance transport or by EMS but without prehospital identification of sepsis. We tested the association between prehospital sepsis identification and mean time to first antibiotic and fluid administration using Kruskal-Wallis tests.

Results: Our cohort included 10 EMS sepsis identified patients, 20 patients transported by EMS without prehospital sepsis identification, and 20 non-ambulance arrivals. Mean time to first antibiotic was lower among patients with prehospital sepsis identification, compared to patients transported by EMS without prehospital identification, and patients arriving by non-ambulance transport (1.3 vs 2.0 vs 2.7 hours, respectively; p=0.043). Time to fluid administration was similarly lowest with prehospital identification (0.42 vs 1.6 vs 2.1 hours, respectively; p=0.0001).

Conclusion(s): The implementation of the Maryland EMS prehospital sepsis identification criteria significantly reduced the time to first antibiotic and fluid administration compared to cases without prehospital sepsis identification, supporting the effectiveness of early sepsis recognition and intervention by prehospital providers in improving timely treatment of pediatric sepsis.