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Novel Pediatric Sepsis Criteria and Clinical Decision Support Tools

新型儿科败血症标准和临床决策支持工具

基本信息

批准号：
10684927
负责人：
Tellen Bennett
金额：
$ 63.36万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10684927
关键词：
Acceleration Accident and Emergency department Address Adult Advisory Committees Affect Bangladesh Caring Cessation of life Child Childhood China Clinical Clinical Data Colombia Country Critical Care Critically ill children Data Databases Development Diagnosis Disease Early Diagnosis Early identification Electronic Health Record Emergency Care Environment Functional disorder Health Priorities Heart Hospital Mortality Human body Immune response Income Infection Inpatients Institution Intensive Care Units International Kidney Life Lung Measures Medicine Modeling Organ Organ failure Patients Pediatric Hospitals Public Health Publishing Resource-limited setting Resources Role Science Sepsis Site Societies Specificity System Systemic Inflammatory Response Syndrome Techniques Update Work clinical care clinical decision support computing resources data resource design effective therapy global health health care availability high risk improved improved outcome innovation inpatient service low and middle-income countries mobile application mortality mortality risk novel pediatric emergency pediatric sepsis prototype response risk stratification support tools temporal measurement unnecessary treatment

项目摘要

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 However, the current criteria to diagnose pediatric sepsis are outdated, lack specificity, do not allow early detection and risk stratification in all settings, and are discordant with clinician-based diagnosis.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.

项目概要/摘要儿童败血症是一个重大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情况下的风险分层，并且与临床医生的诊断不一致。 2016 年，成人脓毒症 3 特别工作组将脓毒症重新定义为“因宿主反应失调而引起的危及生命的器官功能障碍”。感染”，强调了器官功能障碍在脓毒症病理生理学中的关键作用。重要的是，它们使用数据驱动的方法。然而，成人 Sepsis-3 标准因其局限性而受到批评适用于重症监护病房外和资源有限的环境。儿科标准仍然基于关于全身炎症反应综合征和未经验证的器官功能障碍标准。 2019年，重症监护医学协会和其他主要全球组织赞助创建了儿科脓毒症定义工作组更新儿科脓毒症的定义和操作标准。整体该提案的目的是推导并验证新的儿科脓毒症标准，该标准可推广到超越 ICU 和不同资源的环境。新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最适合新的儿科治疗脓毒症标准。此外，目前还没有儿科急诊和住院数据库推导和验证新脓毒症标准所需的粒度和广泛代表性。在这个提案中，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。我们将延长我们的之前的工作并利用我们国际调查团队的专业知识来建立一个大型的、集中的两国机构的儿科急诊和住院护理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标如下： 1) 确定不同儿科器官功能障碍的最佳临床标准资源设置和护理环境，2) 制定和验证新的儿科脓毒症标准，以及 3) 设计，构建并评估原型 CDS 工具，以促进新的儿科脓毒症标准的使用。我们已经集合了一个在该领域拥有成功记录的调查团队，并将与儿科合作败血症定义工作组致力于解决这一全球卫生优先事项。我们预计该提案的结果对儿科脓毒症和器官功能障碍的科学产生强大而持续的影响，并最终提高脓毒症识别率，加速适当有效的治疗，减少不必要的治疗，以及改善世界各地败血症儿童的治疗结果。

项目成果

期刊论文数量（15）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Derivation, validation, and transcriptomic assessment of pediatric septic shock phenotypes identified through latent profile analyses: Results from a prospective multi-center observational cohort.

通过潜在特征分析确定的儿科感染性休克表型的推导、验证和转录组学评估：来自前瞻性多中心观察队列的结果。

DOI：
10.21203/rs.3.rs-3692289/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Atreya,MihirR;Huang,Min;Moore,AndrewR;Zheng,Hong;Hasin-Brumshtein,Yehudit;Fitzgerald,JulieC;Weiss,ScottL;Cvijanovich,NatalieZ;Bigham,MichaelT;Jain,ParagN;Schwarz,AdamJ;Lutfi,Riad;Nowak,Jeffrey;Thomas,NealJ;Quasney,Mic
通讯作者：
Quasney,Mic

Development of a Pediatric Blood Pressure Percentile Tool for Clinical Decision Support.