Early Sepsis in Children Assessment by Parents: an Evaluation

Abstract

Sepsis is one of the leading causes of death in children worldwide. The death rate among children caused by sepsis is around 10-20% globally. No figures are available in the UK about the number of deaths in children who suffered from sepsis. However, fever often indicates the onset of an infection or sepsis in children. Current figures indicate that parent-reported symptoms of fever in their child range between 20-40% and fever is the second most common cause of a child’s hospital admission. Although most children with fever suffer from a viral infection, it could be possible that a child is suffering from a serious bacterial infection (sepsis). Thus, early recognition of signs and symptoms of sepsis is crucial and influences the survival of children.

Two interventions have been developed to improve early sepsis recognition in children: the Sepsis Assessment & Management (SAM) leaflet for parents and the Desktop SAM application for General Practitioners (GPs). Both tools have been designed to connect the observations of the parents to the observations of the GPs and to support a common language understanding each other observations. The SAM leaflet uses amber and red fields to look for signs and symptoms: (1) Colour, (2) Activity, (3) Breathing, (4) Circulation, (5) Temperature & Body, and (6) Vomiting, Diarrhoea and Hydration. The leaflet also provided details regarding who to contact in case symptoms appear in the amber or red areas. Similar features are incorporated in the Desktop SAM. Both interventions were based on the NICE guideline ‘Feverish illness in children’ and developed with a large group of stakeholders, including parents.

This project aimed to evaluate the feasibility and pilot the implementation of the SAM leaflet and the Desktop SAM. Specifically, the objectives were to evaluate the use of the SAM leaflet by parents and GPs, and to evaluate the application and effectiveness of the Desktop SAM at GP practices. The methods used in the project were online surveys for parents and GPs and interviews with GPs. The survey for parents included questions about the experiences of using the SAM leaflet, their experiences with a GP visit, and also a standard questionnaire about the empowerment of families related to the health services of their children. The survey of the GPs asked questions about the use of the Desktop SAM application, the content, and how it helped them in making decisions about diagnosis and management of the sick child.

In total, 77 parents completed the online survey. Of these, 12 parents completed the questions related to the SAM leaflet, 66 parents completed the GP questions and 49 parents completed the questions about family empowerment. The parents were positive about the SAM leaflet and found the leaflet useful, as one parent wrote: ‘Very useful for deciding whether to get further advice or not’. The majority of the parents were satisfied with their GP visit and they were treated with respect and giving enough time. The parents who responded to the family empowerment questions felt fairly confident about their child health services. However, 24% of the parents stated ‘sometimes’ when asked if they know what services their child needs. This was in line with the question if parents have a good understanding of the health service system for their child; only 18% of the parents stated ‘very often’ on this topic. Therefore, the SAM leaflet might provide guidance to parents to contact the right health service at the right time, in order for their child to receive the right care.

The GP survey revealed a positive attitude toward the Desktop SAM. Nearly 70% of the GPs found that the Desktop SAM contributed to their clinical assessment. More than 60% of the GP were positive about the Desktop SAM and thought this application assists them in clinical decision-making. Some suggestions were made to improve the Desktop Sam, which were mostly related to adding space for notes of the overall history taking and management plan. The interviews with the GPs revealed that there was an overall positive experience about the usability of the Desktop SAM. The application was found to be easy for data entry and was seen as a good ‘prompt’ tool. Also, the GPs found that the Desktop SAM provided a good reference for supporting parents, particular the option to print the SAM leaflet directly from the application and discuss the leaflet with the parent.

Although this project has some limitations, such as the number of parents and GPs responding to the surveys, it is believed that the SAM leaflet and Desktop SAM can play a key-role in recognising early sepsis and timely treatment of sick children. Therefore, the recommendations are related to further implementation of the SAM leaflet and the Desktop SAM on a regional and national level.

Recommendations for SAM leaflet: 1. Develop a strategy to implement the SAM leaflet with a clear pathway to increase the awareness of the leaflet in the wider public, with a special focus on parents. 2. Develop an educational strategy for parents and healthcare professionals to increase the knowledge and understanding of the SAM leaflet. 3. Evaluate the SAM leaflet by assessing the effectiveness, understanding the change when using the SAM leaflet, and assess the cost-effectiveness.

Recommendations for Desktop SAM: 1. Develop a strategy to implement the Desktop SAM in healthcare settings. 2. Develop an educational strategy for healthcare professionals to increase the knowledge and understanding of the Desktop SAM. 3. Evaluate the Desktop SAM by assessing the effectiveness, understanding the decision-making processes, and assess the cost-effectiveness.

The development of the SAM leaflet and Desktop SAM was prompted by the tragic death from sepsis of a 3 year old child called Sam. The wider implementation and dissemination of the SAM leaflet and Desktop SAM needs to be undertaken by a collaborative network of parents, healthcare professionals, and other stakeholders. After all, parents, healthcare professionals, the NHS, the public, and politicians do not want to experience a so-called ‘never event’ again with the result of an unnecessary death of a child.