Halden Scott

University of Colorado | UCD · Department of Pediatrics

Introduction Determining which febrile pediatric hematology/oncology (PHO) patients will decompensate from severe infection is a significant challenge. Serum lactate is a well-established marker of illness severity in general adult and pediatric populations, however its utility in PHO patients is unclear given that chemotherapy, organ dysfunction,...

Study objective Sepsis is a leading cause of pediatric death requiring emergency resuscitation. Most children with sepsis are treated in general emergency departments (EDs); however, research has focused on pediatric EDs. We sought to identify barriers and facilitators to pediatric sepsis care in general EDs, including care processes, the role of g...

BACKGROUND AND OBJECTIVES Serious bacterial infection (SBI) is common in the PICU. Antibiotics can mitigate associated morbidity and mortality but have associated adverse effects. Our objective is to develop machine learning models able to identify SBI-negative children and reduce unnecessary antibiotics. METHODS We developed models to predict SBI...

Importance: Pediatric sepsis definitions have evolved, and some have proposed using the measure used in adults to quantify organ dysfunction, a Sequential Organ Failure Assessment (SOFA) score of 2 or more in the setting of suspected infection. A pediatric adaptation of SOFA (pSOFA) showed excellent discrimination for mortality in critically ill c...

Study objective To determine whether the receipt of more than or equal to 30 mL/kg of intravenous fluid in the first hour after emergency department (ED) arrival is associated with sepsis-attributable mortality among children with hypotensive septic shock. Methods This is a retrospective cohort study set in 57 EDs in the Improving Pediatric Sepsis...

The Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes (IPSO) collaborative is a multi-center quality improvement (QI) learning collaborative of 61 U.S. children’s hospitals that seeks to improve sepsis outcomes through collaborative learning and reliable implementation of evidence-based interventions in pediatric emergency depar...

Background: Children who are critically ill with AKI suffer from high morbidity and mortality rates, and lack treatment options. Emerging evidence implicates the role of complement activation in AKI pathogenesis, which could potentially be treated with complement inhibitors. The purpose of this study is to evaluate the association between compleme...

Objective: To determine the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with: 1) sepsis, severe sepsis, or septic shock in children with infection and 2) multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock. Data sources: MEDLINE, Embase, and th...

Introduction: Confidence-weighted testing assesses learners' beliefs about their knowledge and skills. As part of a hospital-wide quality improvement initiative to enhance care for pediatric patients with suspected sepsis, we developed a novel intervention using confidence-weighted testing to identify institutional areas of misinformation and know...

Background and objectives: Pediatric sepsis quality improvement in emergency departments has been well described and associated with improved survival. Acute care (non-ICU inpatient) units differ in important ways, and optimal approaches to improving sepsis processes and outcomes in this setting are not yet known. Our objective was to increase the...

Background: A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across...

Pediatric sepsis is a major public health problem. Published treatment guidelines and several initiatives have increased adherence with guideline recommendations and have improved patient outcomes, but the gains are modest, and persistent gaps remain. The Children's Hospital Association Improving Pediatric Sepsis Outcomes (IPSO) collaborative seeks...

Objectives: To use electronic health record data from the first 2 hours of care to derive and validate a model to predict hypotensive septic shock in children with infection. Design: Derivation-validation study using an existing registry. Setting: Six emergency care sites within a regional pediatric healthcare system. Three datasets of unique...

Objectives: Bundled pediatric sepsis care has been associated with improved outcomes in tertiary pediatric emergency departments. Sepsis care at nontertiary sites where most children seek emergency care is not well described. We sought to describe the rate of guideline-concordant care, and we hypothesized that guideline-concordant care in communit...

Objectives: To describe the Children's Hospital Association's Improving Pediatric Sepsis Outcomes sepsis definitions and the identified patients; evaluate the definition using a published framework for evaluating sepsis definitions. Design: Observational cohort. Setting: Multicenter quality improvement collaborative of 46 hospitals from Januar...

Objective To evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of ED encounters for children with suspected sepsis, in view of similar associations in adults. Study design Laboratory and clinical data were extracted from a registry of Emergency Department (ED) encounters of c...

Objectives To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public...

Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three pu...

In 2001, the Surviving Sepsis Campaign (SSC) began to develop evidence-based guidelines and recommendations for the resuscitation and management of patients with sepsis. With the 2016 edition, the Society of Critical Care Medicine and European Society of Intensive Care Medicine recommended a separate task force be dedicated to guideline formulation...

Severe sepsis requires timely, resource-intensive resuscitation, a challenge when a sepsis diagnosis is not confirmed. The overall goals were to create a pediatric sepsis program that provided high-quality critical care in severe sepsis (Sepsis Stat), and, in possible sepsis, flexible evaluation and treatment that promoted stewardship (Sepsis Yello...

Objective: To derive and validate a model of risk of septic shock among children with suspected sepsis, using data known in the electronic health record at hospital arrival. Study design: This observational cohort study at 6 pediatric emergency department and urgent care sites used a training dataset (5 sites, April 1, 2013, to December 31, 2016...

Objective: Guidelines exist for care of pediatric sepsis, but no study has assessed the benefit of electronic learning (eLearning) in this topic area. The objective of this multicenter study was to assess knowledge acquisition and retention for pediatric sepsis across multiple health care provider roles, using an adaptive and interactive eLearning...

To the Editor Dr Evans and colleagues demonstrated that delivery of bundled care within 1 hour was associated with a significant reduction in pediatric sepsis mortality in 59 hospitals in New York State, although individual bundle elements were not.¹ Prior pediatric studies have similarly shown that timely bundled sepsis care was associated with im...

Clinical care of pediatric sepsis depends upon early recognition and basic initial steps and thus focused educational materials for providers in these early phases of care are needed. The authors sought to identify educational goals and establish a framework for those materials. The authors conducted a Delphi process to create consensus educational...

Objective: The aim of this study was to identify emergency department (ED) heart rate (HR) values that identify children at elevated risk of ED revisit with admission. Methods: We performed a retrospective cohort study of patients 0 to 18 years old discharged from a tertiary-care pediatric ED from January 2013 to December 2014. We created percen...

Objectives: To assess whether the risk of missed clinician diagnosis of pediatric sepsis requiring care in the intensive care unit (ICU) was greater in community vs tertiary pediatric emergency care settings with sepsis pathways. Study design: An observational cohort study in a tertiary pediatric emergency department (ED) staffed by pediatric em...

Objectives: Intubation in critically ill pediatric patients is associated with approximately 20% rate of adverse events, but rates in the high-risk condition of sepsis are unknown. Our objectives were to describe the frequency and characteristics of tracheal intubation adverse events in pediatric sepsis. Design: Retrospective cohort study of a s...

In Reply We thank Schlapbach et al for their letter and their analyses showing the comparability of the association between venous and arterial lactate and odds of mortality in children critically ill with infection.

Objectives: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock." Design: Society of Cri...

Objectives: To assess the validity of Vasoactive-Inotropic Score as a scoring system for cardiovascular support and surrogate outcome in pediatric sepsis. Design: Secondary retrospective analysis of a single-center sepsis registry. Setting: Freestanding children's hospital and tertiary referral center. Patients: Children greater than 60 days...

Background.: Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children's Hospital Colorado implemented a clinical care guideline (CCG) for these infections. The purpose of this study is to evaluate clinical an...

Importance: Improving emergency care of pediatric sepsis is a public health priority, but optimal early diagnostic approaches are unclear. Measurement of lactate levels is associated with improved outcomes in adult septic shock, but pediatric guidelines do not endorse its use, in part because the association between early lactate levels and mortal...

We read with interest the article by R. Andrew Taylor et al.(1) This article highlights the potential of random forest to correctly classify sepsis in-hospital mortality. The authors demonstrate superior predictive performance of random forest over methods traditionally used in emergency medicine, classification and regression tree (CART) and a gen...

Objectives: To evaluate whether lactate clearance and normalization during emergency care of pediatric sepsis is associated with lower rates of persistent organ dysfunction. Study design: This was a prospective cohort study of 77 children <18 years of age in the emergency department with infection and acute organ dysfunction per consensus defini...

Reprint: The American Heart Association requests that this document be cited as follows: de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt E, Schexnayder SM, Samson RA. Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resusc...

Objectives: To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard. Study design: Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classifica...

Bacterial sepsis is a leading cause of pediatric morbidity and mortality worldwide. Early diagnosis, a coordinated and aggressive approach to initial resuscitation, and timely and appropriate antibiotic therapy are paramount to improving outcomes of these dangerous infections. The basic tenants of initial and ongoing resuscitation include rapid iso...

Objectives This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits.Methods This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-s...

Early detection of compensated pediatric septic shock requires diagnostic tests that are sensitive and specific. Four physical exam signs are recommended for detecting pediatric septic shock prior to hypotension (cold extremities, mental status, capillary refill, peripheral pulse quality); this study tested their ability to detect patients who deve...

Objectives: To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Design: Observational cohort study from 2004 to 2012. Setting: Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database. Patients: Chil...

Purpose: Several strategies have been used to identify pediatric patients with severe sepsis using administrative data, including ICD-9 codes for infection combined with organ dysfunction and, since 2003, sepsis-specific codes. Recent data in adults suggests a three-fold difference in epidemiological estimates related to the method of database abst...

Failure to recognize shock contributes to inadequate early resuscitation in many children with sepsis. Serum lactate levels are used to identify adult patients with septic shock, but physical examination diagnosis alone is recommended in pediatric sepsis. The authors sought to test the utility of lactate testing in pediatric emergency department (E...

Despite rapidly increasing incidence of skin and soft tissue infections (SSTIs) presenting to emergency departments (EDs), outcome data for these infections are limited. This is a retrospective cohort study of children with culture-positive SSTI, managed as outpatients from a large pediatric ED in the year 2006. The primary outcome was treatment fa...

Background: Early recognition and treatment of sepsis improves survival, but recognition of pediatric sepsis prior to decompensation is difficult. Sepsis therapy is invasive and resource-intensive and thus tests to identify patients requiring treatment must be both specific and sensitive. Current guidelines for management of pediatric sepsis recomm...

Gram-positive organisms are the most common infectious etiologic agents in skin abscesses. Empiric antimicrobial treatment choices are influenced by this knowledge. In this report, we describe a high prevalence of Proteus mirabilis, a Gram-negative bacillus, in skin abscesses of the axilla, which has potential implications for selection of antimicr...

Skin and soft tissue infections (SSTIs) are increasing in incidence, yet there is no consensus regarding management of these infections in the era of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This study sought to describe current pediatric emergency physician (PEP) management of commonly presenting skin infections....