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 However, the current criteria to diagnose pediatric sepsis are outdated, lack specificity, do not allow early detection and risk stratification in all settings, and are discordant with clinician-based diagnosis.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

项目摘要/摘要小儿脓毒症是每年数百万死亡的主要全球公共卫生问题。然而，诊断儿科败血症的当前标准已过时，缺乏特异性，不允许早期检测和在所有情况下的风险分层，并且与基于临床的诊断不一致。 2016年，成人Sepsis-3 工作队重新定义败血症为“威胁生命的器官功能障碍，由宿主对宿主反应失调引起感染，“强调器官功能障碍在败血症的病理生理学中的关键作用。重要的是，它们使用了数据驱动的方法。但是，成人Sepsis-3标准对于有限的重症监护室外和资源有限设置之外的适用性。小儿标准仍然基于关于系统性炎症反应综合征和未验证器官功能障碍标准。 2019年重症监护医学学会和其他主要全球组织赞助了小儿的创建败血症定义工作组更新小儿脓毒症的定义和操作标准。总体该提议的目的是得出并验证新型的小儿脓毒症标准，该标准概括了 ICU和不同采购的设置。新标准将基于器官的度量功能障碍。但是，尚不清楚哪种器官功能障碍措施最适合新的儿科败血症标准。此外，目前没有儿科紧急和住院数据库粒度和广泛的表示，以得出和验证新的败血症标准。在这个建议中，我们将解决这些关键差距，以促进小儿败血症的科学和临床护理。我们将扩展我们的先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式来自两者的机构的小儿紧急和住院护理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。我们将使用这些丰富的临床数据来完成以下目的：1）确定每个小儿器官功能障碍的最佳临床标准资源丰富的设置和护理环境，2）开发和验证新型的小儿脓毒症标准，3）设计，构建并评估原型CDS工具，以促进新的儿科败血症标准的使用。我们已经组装了一个调查团队在该领域取得了成功的记录，并将与小儿合作合作败血症定义工作队以解决这一全球健康优先级。我们希望该提议的结果能对小儿败血症和器官功能障碍的科学的强大而持续的影响，最终改善脓毒症的识别，加速适当的有效治疗，减少不必要的治疗以及改善世界各地败血症儿童的结果。

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.

DOI：
10.1001/jamanetworkopen.2022.36918
发表时间：
2022-10-03
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Martin, Blake;DeWitt, Peter E.;Albers, David;Bennett, Tellen D.
通讯作者：
Bennett, Tellen D.

Commentary: 'Critical illness subclasses: all roads lead to Rome'.

DOI：
10.1186/s13054-022-04265-w
发表时间：
2022-12-14
期刊：
Critical care (London, England)
影响因子：
0
作者：
通讯作者：

Patterns of Organ Dysfunction in Critically Ill Children Based on PODIUM Criteria.

DOI：
10.1542/peds.2021-052888p
发表时间：
2022-01-01
期刊：
PEDIATRICS
影响因子：
8
作者：
Sanchez-Pinto, L. Nelson;Bembea, Melania M.;Farris, Reid Wd;Hartman, Mary E.;Odetola, Folafoluwa O.;Spaeder, Michael C.;Watson, R. Scott;Zimmerman, Jerry J.;Bennett, Tellen D.
通讯作者：
Bennett, Tellen D.

Derivation and Validation of Vasoactive Inotrope Score Trajectory Groups in Critically Ill Children With Shock.