To systemically review, critically appraise, and synthesise information on the time to positivity of blood cultures in children admitted to paediatric services with suspected sepsis.

Relevant electronic sources will be searched for clinically relevant prediction studies including MEDLINE, MEDLINE in-Process & Other non-Indexed Citations, EMBASE, CDSR, CENTRAL (via the Cochrane Library), HTA, and DARE. (See Appendix 1). Reference lists of relevant systematic reviews and included articles will also be reviewed. Authors of relevant studies may be contacted as time allows to seek further studies, as this is likely to be a poorly indexed area of biomedical research. Published and unpublished studies will be sought and no language restrictions applied. Non-English language studies will be translated if time permits.

Observational studies are the only study design likely to be available to answer this question.

Suspected sepsis in the paediatric population.

Children or young adults (aged 1 month – 18 years) who are admitted to paediatric services who have blood cultures sent as part of their investigation.

Time to positivity of blood culture results. If negative at 36hours, can antibiotics be stopped?

None

Primary outcomes

Outcomes (any of) Blood cultures positive for a clinically significant organism, time to positivity of culture (as a continuous variable or as ‘chunks’ of time with the ability to differentiate at 36 and 48 hours).

Secondary outcomes

None

Two reviewers will independently screen the title and abstract of studies for inclusion. Disagreements will be resolved by consensus, or if this proves impossible, by recourse to an independent adjudicator. Data will be extracted by one researcher using a standardised data extraction form and independently checked by a second.

The quality of studies will be assessed by using a quality assessment tool based on “Systematic reviews: CRD's guidance for undertaking reviews in health care” (2009) which draws on the QUADAS checklist, supplemented with information about potential sources of heterogeneity: patient demographic and clinical characteristics, study era, geography and antibiotic use. In addition, information will be extracted on any cutpoints used (with the technique for derivation), and methods of statistical analysis, including variables adjusted for.

Key study characteristics, the accuracy of predictor variables and study quality will be summarised in narrative and tabular forms.

If it is considered appropriate (based on clinical and statistical homogeneity and the necessary data being available) appropriate meta-analytical methods will be used. These may include the use of pooled likelihood ratios and hierarchical summary receiver operator characteristic (HSROC) curve modelling with binary data. Data which are adjusted for other known prognostic markers (for example, clinical features suggestive of poor clinical outcome) will be pooled separately from unadjusted estimates.

Heterogeneity will be explored through consideration of study populations, study quality, and predictor variables assessed and in statistical terms using the tau squared statistic.

None planned

The results of this review will be submitted for publication in a scholarly journal following the PRISMA reporting guidelines as closely as possible. Lay and professional summaries of the project will be available from the authors and submitted for publication.

Jessica Morgan

The Coach House, St Ann's Hill,

81 St Ann's Lane,

Leeds, LS4 2SG

cosmicjess@hotmail.co.uk

None

Dr Jessica Morgan,
Dr Bob Phillips,
Dr Rebecca Powell,

14 September 2012

28 June 2013

None

None known

English

England

Subject indexing assigned by CRD

Blood; Child; Culture Media; Humans; Pediatrics; Sepsis; Time Factors

19 September 2012

19 September 2012