Diagnostic Approach

The diagnosis of pediatric sepsis involves a multifaceted approach, including clinical assessment, laboratory data, imaging, cultures, and consideration of organ dysfunction criteria.

Key aspects include:

• Clinical evaluation for signs/symptoms of infection and organ dysfunction
• Vital signs showing tachycardia, tachypnea, fever/hypothermia, hypotension in severe cases
• Detailed history of presenting illness, risk factors, comorbid conditions
• Physical exam findings like rash, respiratory distress, altered mental status
• Laboratory tests: CBC, CRP, procalcitonin, lactate, blood cultures, urinalysis/culture as indicated
• Imaging like chest X-ray, abdominal ultrasound to identify potential infection source
• Application of consensus criteria for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis
• Evaluation for sepsis-induced organ dysfunction using pediatric SOFA score
• Bedside cardiovascular monitoring: blood pressure, echocardiography
• Other advanced monitoring like central venous oxygen saturation when indicated

A high index of suspicion is required. Diagnostic uncertainty should not delay empiric broad-spectrum antibiotics and fluid resuscitation when sepsis is suspected.