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Angkor Hospital for Children.
A new study published in Nature Medicine suggests that a revised approach to paediatric triage could help prevent thousands of deaths and reduce unnecessary referrals in resource-constrained and conflict-affected settings.
The Spot Sepsis study was led by researchers from the Mahidol Oxford Tropical Medicine Research Unit (MORU), a research unit within the University of Oxford’s Nuffield Department of Medicine, and Médecins Sans Frontières (MSF). The researchers found that new prognostic tools outperformed current international standards for identifying which febrile children require urgent hospital referral.
In many remote communities, infectious diseases remain the leading cause of death for children under five, often because health workers lack the tools to recognise impending sepsis before it is too late. The study found that the current World Health Organization (WHO) danger signs would have missed nearly half (44.5%) of the children who eventually progressed to death or required organ support.
By contrast, the research team's new models, which combine simple and accessible clinical signs with pulse oximetry or a blood test called sTREM1, would have identified approximately 89% of these high-risk children. Overall recommended referral rates using the new tools were also projected to fall from 17% to less than 5%.
"Our results show that by using simple and accessible clinical signs, alongside tools like pulse oximetry or a rapid blood test, we could not only identify more sick children but also drastically reduce unnecessary referrals, ensuring limited hospital resources are reserved for those in greatest need", said lead author Dr Arjun Chandna, Clinical Researcher at the Cambodia Oxford Medical Research Unit, part of MORU.
"MSF operates in remote and conflict-affected areas where reaching higher-level care is often irregular and fraught with difficulty. A simple, deployable tool that enables health workers in decentralised care settings to correctly identify children at high risk of sepsis would be invaluable," said Dr Sakib Burza, MSF Principal Investigator of the study.
Spot Sepsis is the largest study to date investigating the clinical utility of host biomarkers in the prognosis of childhood febrile illness, and the first study conducted at the community-level. Between 2020 and 2022, the team followed 3,500 children across seven rural sites in Bangladesh, Cambodia, Indonesia, Laos, and Viet Nam. The study concludes that use of these tools, as well as saving lives, could be highly cost-effective.
"Compared to current WHO criteria, all these approaches are likely to be cost-saving, while strategies incorporating pulse oximetry or the host biomarker sTREM1 remain highly cost-effective compared to use of simple clinical signs alone", said Oxford Professor Yoel Lubell, a MORU Bangkok-based health economist and Principal Investigator of the study.
Pulse oximetry-based triage was projected to cost just $26.28 per life-year saved, underscoring the potential value of future integration into humanitarian operations and primary care systems worldwide.
Spot Sepsis was funded by MSF and Wellcome.
Predicting referral need for febrile children in low-resource community settings in South and Southeast Asia is available via Open access, in Nature Medicine. Published: