Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce.

Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a "Think globally, act locally" approach is required.
Competing Interests: Dr. Carrol received support for article research from the U.K. National Institute for Health and Care Research. Dr. Bennett’s institution received funding from the National Heart, Lung, and Blood Institute and the National Center for Advancing Translational Sciences. Drs. Bennett and Zimmerman’s institutions received funding from the National Institute of Child Health and Human Development. Drs. Bennett and Randolph received support for article research from the National Institutes of Health. Dr. Zimmerman’s institution received funding from Immunexpress; he received funding from Elsevier Publishing. Dr. Sorce disclosed she is a Society of Critical Care Medicine (SCCM) Executive Board Member. Dr. Randolph’s institution received funding from the U.S. Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases; she received funding from UpToDate; she disclosed she is Chair of the International Sepsis Forum. Ms. Harmon disclosed she is an employee of SCCM. Dr. Argent received travel, accommodation, and registration fees to attend a number of conferences as an invited guest speaker and received fees for provision of expert opinion in a number of medicolegal cases (from several legal firms in South Africa). The remaining authors have disclosed that they do not have any potential conflicts of interest..
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)