- Design
- Multicentre prospective observational cohort
- Population
- 5,119 children with suspected community-acquired sepsis in 11 EDs
- Primary outcome
- Corticosteroid use within 24 hours: agent, dose, associated factors
- Effect
- 9.6% received steroids overall; 31.3% of those meeting Phoenix criteria
A prospective cohort in Archives of Disease in Childhood (29 September) followed 5,119 children admitted with suspected community-acquired sepsis through 11 emergency departments in Australia and New Zealand. Mortality was 1.0% overall and 12.7% among the 252 who met the Phoenix sepsis criteria.
Corticosteroids were given within 24 hours to 9.6% overall and 31% of those meeting Phoenix criteria. Dexamethasone was used most (70%), then hydrocortisone (25%), with wide variation between sites. Most use was outside fluid- or catecholamine-refractory shock, the only setting where guidance supports hydrocortisone.
The pattern suggests steroids are being given for other reasons — croup, asthma, presumed meningitis — or by habit. Without trial evidence for routine use, this variation is an opportunity to tighten practice.
- Reserve hydrocortisone in sepsis for fluid- and catecholamine-refractory shock
- Record the indication when giving steroids to a child with sepsis
- Dexamethasone for suspected bacterial meningitis follows its own guidance
- Audit local steroid use in sepsis against the refractory-shock criterion
Why it matters
Steroids are being given far beyond the narrow setting where any evidence supports them.
Don't overread it
A descriptive cohort — it cannot say whether steroids helped or harmed.
The statistics, in plain English
These are proportions, not effects: the study describes who received steroids, not what happened because of them.
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