Pediatric Sepsis Screening

Patient ID: Who is filling the form? Doctor
Nurse

Staff Number: Location of the patient: Date: Time of Screening:
Pediatric Early Warning Score (PEWS):
Are any of the following complaints given by the caregiver? Fever
Reduced activity or alertness
New onset of infective symptoms
Central line associated infection
None of the above

Risk Factors: Less than 3 months of age
Central line in situ
Immunocompromised (on IVIG or Steroids)
Received Chemotherapy < 6month ago
Post Organ Transplant
Chronic illness (SCD , Cadiac, renal or lung disease)
None of the above

Red Flags: Bardy/Tachypnea
Bardy/Tachycardia
Hypotension
Delayed Cap Refill
Cool/Motteled Skin
Altered Mental Status
Fever or Hypothermia < 35*c
None of the above

Sepsis Improvement Committee
Dr.Sufyan Alrahbi - Pediatric Emergency Medicine