Paediatric sepsis remains a major cause of morbidity and mortality worldwide [1]. Early recognition and timely treatment are associated with improved outcomes, particularly before progression to shock and organ dysfunction [2, 3]. However, recognising sepsis in children remains difficult. Clinical features overlap with common viral illnesses, physiological parameters vary with age and hypotension is often a late sign in children [2, 4].
Driver et al. review the impact of automated electronic medical record (EMR)‐based sepsis alerts in paediatric practice [5]. Their systematic review included 12 studies across emergency departments, inpatient wards and paediatric intensive care units.
The review found that automated alerts were more consistently associated with improvements in process measures than clinical outcomes. Several studies reported reduced time to antibiotics, earlier fluid administration and improved adherence to sepsis bundles following implementation of automated alerts [5]. These findings are clinically relevant, as delayed treatment has been associated with poorer outcomes in sepsis [2, 3].
The effect on mortality and other clinical outcomes was less clear. Only one study demonstrated a significant reduction in mortality following implementation of an electronic alert system [5]. Most studies showed no significant change in mortality, paediatric intensive care admission rates or length of stay.
Interpretation of these findings requires caution. Most included studies used pre‐ and post‐intervention designs that are vulnerable to confounding. Many studies introduced alerts alongside education, sepsis pathways and multidisciplinary review, making it difficult to isolate the effect of the alert alone.
Another challenge is the heterogeneity between studies. Alert criteria, sepsis definitions, patient populations and outcome measures varied considerably [5]. Time zero also differed between studies, ranging from triage time to alert activation or blood culture collection. These differences limit direct comparison between studies and make pooled interpretation difficult.
The review also addresses concerns regarding overtreatment and alert fatigue. Excessively sensitive alert systems may increase unnecessary antibiotic exposure or hospital admissions. Reassuringly, the included studies did not demonstrate increased hospital admission rates or antibiotic utilisation following implementation of automated alerts [5]. However, these balancing measures were inconsistently reported.
In paediatrics, severe sepsis and septic shock are relatively uncommon events compared with adult practice, making mortality studies difficult to power adequately. Improvements in process measures may therefore still represent meaningful improvements in care, even when mortality differences are difficult to demonstrate statistically.
The recently published international consensus criteria for paediatric sepsis may help improve consistency in future studies evaluating electronic screening systems [4]. Further multicentre randomised studies are still required to determine whether automated alerts improve clinical outcomes in children.
The review by Driver et al. provides an important summary of the current evidence. Automated EMR‐based sepsis alerts may assist in the earlier recognition and treatment of paediatric sepsis, particularly when incorporated into structured clinical pathways. Whether these systems independently improve outcomes remains uncertain.
Author Contributions
A/Prof Bhurawala conceptualised and wrote the manuscript and approved the final manuscript.
Funding
The author has nothing to report.
Consent
The author has nothing to report.
Conflicts of Interest
Clinical Professor Bhurawala is a member of the editorial board of the Journal of Paediatrics and Child Health. The views expressed in this commentary are those of the authors and do not necessarily reflect those of the journal or editorial board.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.