Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

A Validation Argument for a Simulation-Based Training Course Centered on Assessment, Recognition, and Early Management of Pediatric Sepsis

Geis, Gary, L., MD; Wheeler, Derek, S., MD; Bunger, Amy, PhD; Militello, Laura, G., MA; Taylor, Regina, G., CRC; Bauer, Jerome, P., RN; Byczkowski, Terri, L., PhD; Kerrey, Benjamin, T., MD, MS; Patterson, Mary, D., MD, MEd

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: February 2018 - Volume 13 - Issue 1 - p 16–26
doi: 10.1097/SIH.0000000000000271
Empirical Investigations

Introduction Early recognition of sepsis remains one of the greatest challenges in medicine. Novice clinicians are often responsible for the recognition of sepsis and the initiation of urgent management. The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting.

Methods Five unique simulation scenarios were developed integrating critical sepsis cues identified through qualitative interviewing. Scenarios were piloted with groups of novice, intermediate, and expert pediatric physicians. The primary outcome was physician recognition of sepsis, measured with an adapted situation awareness global assessment tool. Secondary outcomes were physician compliance with pediatric advanced life support (PALS) guidelines and early sepsis management (ESM) recommendations, measured by two internally derived tools. Analysis compared recognition of sepsis by levels of expertise and measured association of sepsis recognition with the secondary outcomes.

Results Eighteen physicians were recruited, six per study group. Each physician completed three sepsis simulations. Sepsis was recognized in 19 (35%) of 54 simulations. The odds that experts recognized sepsis was 2.6 [95% confidence interval (CI) = 0.5–13.8] times greater than novices. Adjusted for severity, for every point increase in the PALS global performance score, the odds that sepsis was recognized increased by 11.3 (95% CI = 3.1–41.4). Similarly, the odds ratio for the PALS checklist score was 1.5 (95% CI = 0.8–2.6). Adjusted for severity and level of expertise, the odds of recognizing sepsis was associated with an increase in the ESM checklist score of 1.8 (95% CI = 0.9–3.6) and an increase in ESM global performance score of 4.1 (95% CI = 1.7–10.0).

Conclusions Although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.

From the Cincinnati Children's Hospital Medical Center (G.L.G., D.S.W., R.G.T., J.B., T.B., B.T.K.); University of Cincinnati Medical Center (A.B.); Applied Decision Science (L.G.M.), LLC; and Children's National Medical Center (M.D.P.), Cincinnati, OH.

Reprints: Gary L. Geis, MD, Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 12000, Cincinnati, OH 45229-3039 (e-mail:

Supported by the Agency for Healthcare Research and Quality (Grant #1R18HS020455-01).

M.P. performs occasional consulting for SimHealth Group. The rest of the authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2018 Society for Simulation in Healthcare