Sepsis going undetected among Queensland children

Sepsis is the biggest single cause of preventable death of children in Queensland, yet our knowledge of childhood sepsis mortality is limited, with many cases possibly being missed.

• The Queensland Family and Child Commission (QFCC) and the Queensland Paediatric Sepsis Program at Children’s Health Queensland (CHQ) partnered to complete Australia’s first population-based study to better understand the true incidence of childhood deaths from sepsis.
• The study identifies opportunities for practice improvements that can lead to better identification of sepsis in children, including improving death records, increasing parents’ awareness of sepsis and symptoms, and strengthening sepsis recognition guidance and treatment within the primary care sector.

The Queensland paediatric sepsis mortality study set out to identify every sepsis-related child death that occurred in Queensland between 2004 and 2021 in hospitals, at home or in the community to better understand the true incidence of childhood sepsis and to find opportunities to better identify, treat and prevent it.

The analysis found that while childhood sepsis rates have declined over time, attributed largely to public health campaigns, the rate of sepsis-related child deaths continues to be higher than other preventable causes, including transport incidents, suicide and childhood cancers.

The study found 748 Queensland children’s deaths were related to sepsis. Of these, 304 were newborn infants who died in hospital after birth, without ever being discharged home. The remaining 444 were infants and children up to the age of 17. First Nations children were over-represented in the data, accounting for 20 per cent of deaths, a rate three times that of non-Indigenous children.

Rates of sepsis deaths were significantly higher in remote and very remote areas, occurring at nearly 3.5 times the rate of major cities. Children experiencing socio-economic disadvantage were also found to experience higher sepsis mortality rates, likely compounded by reduced access to services.

Almost 30 per cent of sepsis-related deaths occurred outside of hospital, in homes within the community, predominately unexpectedly and among infants and younger children without underlying medical conditions known to increase sepsis risk. Most of these deaths were likely preventable with timely recognition and treatment.

Sepsis recognition outside of hospital is known to be poor. The study found that in 73 per cent of cases, a child saw a health professional up to 24 hours before they died, with children often not identified as being seriously ill.

The study identified five areas to improve the identification, treatment and prevention of childhood sepsis, including:

• improving death certification processes to record sepsis and related information as causing or contributing to the death
• implementing culturally appropriate health campaigns to increase parental and professional awareness of sepsis and its symptoms
• involving a paediatric healthcare professional in coronial investigations of unexpected infection-related child deaths to improve recording of a child’s clinical history.

The study also identified a future research opportunity to understand the drivers of sepsis-related mortality within regional and remote communities, those experiencing socio-economic disadvantage, and among First Nations communities.

Quotes attributed to Dr Paula Lister, Paediatric Intensive Care Specialist, Queensland Children’s Hospital

“Sepsis is the body’s overwhelming and life-threatening response to an infection and is recognised internationally as a leading cause of death in children.

“The accurate recording and surveillance of sepsis-related deaths is limited globally, making it difficult to know the true incidence and outcomes. This study suggests sepsis may be under-diagnosed in Queensland children, particularly in infection-related deaths that occur outside hospitals.

“Children with sepsis can deteriorate very quickly and early detection and treatment are important for survival. Unfortunately, the very early symptoms of sepsis can be subtle, and it is concerning that some parents and primary practitioners may be missing these symptoms.

“Many of these children have also been seen by a health care practitioner within the preceding 24 hours, and it is concerning that parents may not be re-presenting when their child deteriorates; understanding the potential barriers to health-seeking behaviours will be key to any improvement initiatives.

“This paper has identified opportunities to strengthen awareness within the community about sepsis and its risks, but also within clinical practice to better support professionals at the first point of contact.

“The suggested improvements in death certification practice are also critical to informing the research element to our prevention activities and can be implemented very easily with education and practice change.”

Quotes attributed to Queensland Family and Child Commission Principal Commissioner Luke Twyford:

“The death of every child is a tragedy, which is why it’s important we learn as much as we can from every case and use what we find to strengthen our child death prevention strategies and actions.

“This joint study with Children’s Health Queensland—the first of its kind in Australia—provides us with rich insights into the occurrence of sepsis and the opportunities before us to better identify it and keep Queensland children healthy.

“I was concerned to again see First Nations children over-represented in the cases, representing another area where we need to better empower community-controlled organisations to develop and implement health initiatives that will be effective.”

ENDS

A short video about sepsis and its signs is available here: https://youtu.be/lIk9EAwMDZI  

For media information contact:

Queensland Family and Child Commission

Kirstine O’Donnell
Phone: 0404 971 164
Email:   media@qfcc.qld.gov.au

Children’s Health Queensland

Phone: 3068 5111 / 0409 417 194

Email: chqnews@health.qld.gov.au