Novel Pediatric Sepsis Criteria and Clinical Decision Support Tools

项目摘要/摘要 儿科败血症是一个主要的全球公共卫生问题，每年导致数百万人死亡。然而， 目前诊断儿童脓毒症的标准已经过时，缺乏特异性，不允许早期发现和 所有环境中的风险分层，与基于临床医生的诊断不一致。2016年，成年败血症-3 特别工作组将脓毒症的定义重新定义为“由于宿主对 感染“，强调器官功能障碍在脓毒症的病理生理学中的关键作用。重要的是，他们 使用数据驱动的方法。然而，成人脓毒症-3标准因其局限性而受到批评 在重症监护病房之外和在资源有限的环境中的适用性。儿科标准仍然是基于 关于全身性炎症反应综合征和未经证实的器官功能障碍标准。2019年， 重症监护医学会和其他主要的全球组织赞助了儿科 脓毒症定义工作组更新儿童脓毒症的定义和操作标准。整体而言 这项建议的目标是推导和验证新的儿科败血症标准，这些标准超越了 重症监护室和不同资源的设置。新的标准将基于器官的测量 功能障碍。然而，目前尚不清楚哪些器官功能障碍措施对新生的儿科患者是最佳的。 败血症标准。此外，目前还没有儿科急诊和住院病人数据库 推导和验证新的脓毒症标准所需的粒度和广泛的代表性。在这项提案中，我们 将解决这些关键差距，以推进儿科脓毒症的科学和临床护理。我们将延长我们的 并利用我们的国际调查团队的专业知识来建立一个大型的、集中的 两地机构儿科急救和住院治疗的电子健康记录数据库 高收入国家和低收入和中等收入国家。我们将利用这些丰富的临床数据来完成 目的如下：1)确定不同儿科器官功能障碍的最佳临床标准 资源环境和护理环境，2)开发和验证新的儿科败血症标准，以及3)设计， 建立并评估CDS原型工具，以促进新的儿科败血症标准的使用。我们已经集合好了 一支在现场有成功记录的调查小组，并将与儿科 脓毒症定义工作组，以解决这一全球卫生优先事项。我们期待这项提议的结果有 对儿科败血症和器官功能障碍的科学产生了强大而持久的影响，并最终 提高对脓毒症的认识，加快适当有效的治疗，减少不必要的治疗 改善世界各地败血症儿童的预后。

PROJECT SUMMARY/ABSTRACT Pediatric sepsis is a major global public health problem associated with millions of deaths every year. However, the current criteria to diagnose pediatric sepsis are outdated, lack specificity, do not allow early detection and risk stratification in all settings, and are discordant with clinician-based diagnosis. In 2016, the adult Sepsis-3 task force redefined sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection,” emphasizing the pivotal role of organ dysfunction in the pathophysiology of sepsis. Importantly, they used a data-driven approach. The adult Sepsis-3 criteria, however, have been criticized for their limited applicability outside the intensive care unit and in resource-limited settings. The pediatric criteria are still based on the systemic inflammatory response syndrome and unvalidated organ dysfunction criteria. In 2019, the Society of Critical Care Medicine and other major global organizations sponsored the creation of the Pediatric Sepsis Definition Task Force to update the definition and operational criteria for pediatric sepsis. The overall objective of this proposal is to derive and validate novel pediatric sepsis criteria that generalize beyond the ICU and to differently resourced settings. The new criteria will be based on measures of organ dysfunction. However, it remains unknown which organ dysfunction measures are optimal for the new pediatric sepsis criteria. Furthermore, there is currently no pediatric emergency and inpatient database with the granularity and broad representation needed to derive and validate the new sepsis criteria. In this proposal, we will address these critical gaps to advance the science and clinical care of pediatric sepsis. We will extend our prior work and leverage the expertise of our international investigative team to build a large, centralized electronic health record database of pediatric emergency and inpatient care from institutions in both high-income countries and low- and middle-income countries. We will use these rich clinical data to accomplish the following aims: 1) determine the optimal clinical criteria for each pediatric organ dysfunction in differently resourced settings and care environments, 2) develop and validate novel pediatric sepsis criteria, and 3) design, build, and evaluate prototype CDS tools to facilitate use of the new pediatric sepsis criteria. We have assembled an investigative team with a successful track record in the field and will work in partnership with the Pediatric Sepsis Definition Task Force to address this global health priority. We expect the results of this proposal to have a powerful and sustained impact on the science of pediatric sepsis and organ dysfunction and ultimately improve sepsis recognition, accelerate appropriate effective treatment, decrease unnecessary treatment, and improve the outcomes of children with sepsis around the world.