Table 1 Paediatric shock definitions
Guideline | Clinical definition | Limitations |
|---|---|---|
Advanced Paediatric Life Support (APLS) | Compensated: normal blood pressure (BP), but capillary refill time (CRT) >2 s, mottled, cool peripheries, peripheral cyanosis. Decompensated: as above but with hypotension, decreased mental status | Definition of hypotension is separate to shock definition Peripheral cyanosis is rare |
American Academy of Critical Care Medicine – Paediatric Advanced Life Support (ACCM-PALS) | Clinical signs of inadequate perfusion including any of: decreased or altered mental status; CRT >2 s (cold shock) or flash CRT (warm shock), diminished (cold shock) or bounding (warm shock) peripheral pulses, mottled cool extremities (cold shock), or decreased urine output (<1 ml/kg/h) | No specific definition of altered/decreased mental status |
World Health Organization (WHO) | Triad of cold hands and/or feet (temperature gradient), CRT >3 s and weak and fast pulse | Tachycardia not defined alongside shock definition |
Fluid Expansion As A Supportive Therapy (FEAST) study | History of fever and temperature ≥37.5 °C or <36.0 °C and impaired consciousness (prostration or coma) and/or respiratory distress Stratum A (impaired perfusion) Plus ≥1 of: CRT >2 s; lower limb temperature gradient; weak pulse; tachycardia (defined) Stratum B (decompensated shock) Systolic BP <50 mmHg if < 12 months old; <60 mmHg if 1–5 years old; <70 mmHg if > 5 years old |