Pediatric Alert Score (EPA) performance in sepsis screening

This is a diagnostic test study guided by the Standards for the Reporting of Diagnostic Accuracy Studies (STARD) recommendations. The sample consisted of 190 children and adolescents admitted to a hospital in the countryside of Bahia, Brazil. Data collection was carried out in the database of an umbrella project in medical records and the hospital’s records system. Processing and analysis were performed in SPSS^® version 25.0 for Windows and MedCalc^® version 20.00. EPA performance in sepsis screening when compared to the reference standard criteria was measured through sensitivity, specificity, predictive values and ROC curve.

Results

Among the participants, 53.2% were male, with a mean age of 4.39 years (SD: 4.28) and a median of 3 years (IQR: 1 – 8). The prevalence of sepsis identified by the reference standard was 10% and by EPA (23.1%). The sensitivity, specificity and positive and negative predictive values of EPA in sepsis screening were 73.7%, 82.5%, 31.8% and 96.6%, respectively. The area under the ROC curve was 0.794.

Conclusion

The study presents evidence on EPA performance in sepsis screening, demonstrating good accuracy in discriminating pediatric patients with and without sepsis in the studied sample.

Sepsis; Clinical deterioration; Child hospitalized; Pediatric nursing; Validation studies; Early warning score; Early diagnosis

Sociodemographic and clinical characteristics	Frequency n(%)
Sex
Male	101(53.2)
Female	89(46.8)
Age range (years)
0 – 5	122(64.2)
6 – 10	47(24.7)
11 – 15	21(11.1)
Skin color (self-declared)
Black/brown	134(70.5)
Not black/brown	56(29.5)
Origin
Other municipalities	111(58.4)
Feira de Santana	79(41.6)
Family income
Up to one minimum wage	139(73.2)
Above one minimum wage	51(26.8)
Comorbidity
Yes	58(30.5)
No	132(69.5)
Pediatric Alert Score Classification
No signs of deterioration	76(40.0)
Mild signs of deterioration	70(36.8)
Moderate signs of deterioration	30(15.8)
Severe signs of deterioration	14(7.4)

EPA	S	95% CI	Sp	95% CI	PPV	95% CI	NPV	95% CI
≥ 0	100.0	82.4 – 100	-	-	10.0	10.0 – 10.0	-	-
≥ 1	89.5	66.9 – 98.7	43.3	35.7 – 51.1	14.9	12.5 – 17.7	97.4	90.8 – 99.3
≥ 2	73.7	48.8 – 90.9	70.8	63.3 – 77.5	21.9	16.4 – 28.6	96.0	91.9 – 98.1
≥ 3	73.7	48.8 – 90.9	82.5	75.9 – 87.8	31.8	23.4 – 41.6	96.6	93.0 – 98.4
≥ 4	52.6	28.9 – 75.6	90.6	85.3 – 94.6	38.5	24.9 – 54.0	94.5	91.4 – 96.5
≥ 5	26.3	9.1 – 51.2	94.7	90.2 – 97.6	35.7	17.2 – 59.8	92.0	89.8 – 93.8
≥ 6	15.8	3.4 – 33.1	97.1	92.5 – 98.7	33.3	12.0 – 64.8	91.2	89.4 – 92.6
≥ 7	10.5	1.3 – 33.1	100.0	93.3 – 99.0	28.6	7.7 – 65.8	90.7	89.3 – 91.9

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Juliana Freitas Oliveira Miranda E-mail: julidefreitas@hotmail.com/jofmiranda@uefs.br