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Suspecting and spotting paediatric sepsis

The febrile child is one of the most common presentations to the paediatric ED, accounting for 20% of visits. Most cases are benign, selflimiting viral infections. A small proportion will have a serious bacterial infection (SBI) or evolving sepsis. The consequences of failing to recognise and treat paediatric sepsis in a timely manner are devastating and often fatal. For emergency physicians, missing paediatric sepsis is a commonly held fear. There are often minimal clinical signs to herald a serious infection, while bedside tests are not without limitations. In the post-vaccination era, the prevalence of occult bacteraemia and consequent sepsis in the developed world is remarkably low, with reported rates <1%. In our lowprevalence setting, paediatric sepsis therefore represents a relatively rare syndrome with non-specific clinical signs, no perfect diagnostic test but fatal consequences if missed.