The Stillness That Harms: Hidden Delays in Pediatric Sepsis Management within Emergency Care Networks

Abstract

Background:
In pediatric sepsis, each hour of delayed intervention increases the risk of mortality. Yet, despite protocol-driven care, unrecognised delays persist, particularly in busy emergency care networks.

Objective:
To investigate the prevalence, predictors, and outcomes associated with hidden delays (defined as >60 minutes from triage to antibiotic administration) in pediatric sepsis management across emergency departments (EDs).

Methods:
A cross-sectional analysis was conducted across seven emergency centres in France between March 2022 and March 2024. A total of 762 pediatric patients, aged 1 month to 16 years, who met international pediatric sepsis criteria, were enrolled. Time to antibiotics, vital signs, laboratory data, and ED workflow variables were extracted and analysed. Primary outcome: 48-hour clinical deterioration. Secondary outcomes: ICU admission and mortality.

Results:
Hidden delays occurred in 58.6% (n = 447) of cases. The most common contributors were prolonged triage-to-order entry time (average: 39 minutes) and lab turnaround delays (average: 52 minutes). Children with hidden delays had a 2.4-fold increased risk of clinical deterioration (OR: 2.4, 95% CI: 1.7–3.3, p < 0.001). ICU admission occurred in 27.1% of delayed cases, compared to 11.8% in timely-treated patients (p = 0.002). Mortality was 3.6% overall but rose to 6.8% in those with delays.

Conclusion:
Silent delays in the ED—despite protocol compliance—pose a significant threat to pediatric sepsis outcomes. Time-sensitive indicators should be embedded within ED informatics systems to flag hidden lags. Real-time process surveillance, rather than checklist adherence alone, may be the next frontier in pediatric emergency safety.