MICROBIOLOGY


He gave the example of an infant who is 51 days old, with no risk factors: “When he presents to an emergency department, he may or may not appear to be well; he may or may not have a fever. If he has a fever and he’s relatively well appearing, people will make a decision on the risk of having a bacterial infection and what they need to do about it. “If you ask a large group of clinicians what they think the child’s risk of having a serious bacterial infection is – from one to a hundred percent – and you match it to what actually happens, there is zero correlation,” he commented. This is according to the findings of a major study of thousands of infants, he explained, adding that, “These are experienced clinicians who know their game.”


The event discussed a range of issues, from the difficulties of spotting sepsis in busy emergency departments, to achieving antibiotic stewardship in difficult groups.


to the global health emergency of antimicrobial resistance. As Professor Damian Roland pointed out in his opening discussion, decision-making in the emergency room can be particularly challenging, especially when dealing with infants.


An Honorary Professor in Paediatric


Emergency Medicine, at Leicester Hospitals and University, Professor Roland has an international profile in the utilisation of scoring systems to improve the recognition of ill and injured children in emergency and acute care settings. The Paediatric Observation Priority Score (POPS) developed by Professor Roland is highlighted by the Intercollegiate Committee on Standards of Care for Children and Young People in emergency settings.3 POPS is a bespoke Emergency and


Urgent care checklist which quickly scores (between 0-16) acutely ill children on a combination of physiological, behavioural and risk identifiers using easy to collect data. This enables staff (even if inexperienced) to assess, prioritise and


Social challenges


Psychological challenges


Systemic challenges Diagnostic and treatment


Table 1. Recommendations for addressing key decision challenges across different stakeholders. (Source: ‘Decision challenges for managing acute paediatric infections: implications for antimicrobial resistance’4


WWW.PATHOLOGYINPRACTICE.COM DECEMBER 2025


treat acutely ill children, and manage risk in busy clinical areas. Professor Roland opened the discussion by showing the audience a poignant painting by Luke Fildes depicting a doctor looking pensively at a sick child, while his mother and father look on with concerned expressions, in the background.


“Everything I do in my practice is about this triumvirate. It’s about the decision I make; it’s about the child, but it’s also about the caregivers. They are critical to the whole sepsis conundrum,” he asserted. “In an emergency department, we


are extremely busy and have to make rapid decisions all the time,” commented Professor Roland.


He highlighted the significant challenge of making decisions when fatigued – particularly, when undertaking 10-12-hour- long shifts. Industry is aiming to make the decision process easier with “gadgets and tools”, he pointed out, but when it comes to antimicrobial resistance, “there are significant challenges,” he asserted.


Principal (Paediatric Patient) Delivering integrated care through


greater engagement with vulnerable and disadvantaged groups


Putting ‘health’ on the core curriculum at school


Intermediary (Parent/Carer) Delivering integrated care


through greater engagement with vulnerable and disadvantaged groups


Providing evidence-based suite


of resources across a range of languages Re-shaping public debates about litigation


Loss aversion The clinician’s ‘gut feeling’ clearly isn’t accurate, he pointed out, so we need diagnostic tools, but there is also the issue of ‘loss aversion’, which needs to be understood and addressed. Loss aversion can be described as a prominent cognitive bias, by which we fear losses more than desire equivalent gains. There is a feeling that we don’t want to “miss things” or do something that “might cause harm”. “If you are faced with a decision over whether to prescribe antibiotics or not, regardless of what the information says, you have a cognitive design to say, ‘it will be worse if I miss infection than if I save a patient from having antibiotics, successfully’. We are primed cognitively to think that way,” Professor Roland explained.


He went on to consider the probability of illness in paediatric patients in an emergency department: “If I go through a shift and I treat no one, and I choose to make no active decisions at all, I can go two to three shifts and I will never cause harm,” he explained.


“That is the lack of incidence of Agent (Prescriber)


Organisational safety-netting to minimise individual prescriber risks for litigation


Providing targeted decision tools (eg treatment algorithms)


Improved testing of national guidance


to ensure specificity and sensitivity and minimise unintended consequences


Validating diagnostic tools challenges


and evidence-based guidelines for paediatrics


). 39


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60