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Suspected sepsis — DCH MCQ

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HardPaediatric emergenciesSuspected sepsisDCH

A 3-year-old girl presents to the emergency department after 2 days of fever. She has developed a non-blanching purpuric rash and leg pain. She is alert but has mottled skin, a capillary refill time of 4 seconds and a venous lactate of 3.8 mmol/L. Intravenous access has been obtained and a broad-spectrum antimicrobial is ready. Which investigation strategy is most appropriate?

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Correct answer: A — Obtain a blood culture, then give the first antimicrobial dose without awaiting the result

The correct answer is A. Mottled skin and a non-blanching purpuric rash are high-risk sepsis criteria; prolonged capillary refill, leg pain and lactate above 2 mmol/L reinforce the need for urgent management despite preserved alertness. NICE recommends initial venous tests including a blood culture, followed by broad-spectrum antimicrobial treatment without delay and within 1 hour; results must not be awaited. Suspected meningococcal disease guidance gives the same sequence. Lumbar puncture is not the immediate priority in a child with poor perfusion and must not delay treatment. A coagulation screen belongs in the initial blood-test bundle but its result must not determine whether antibiotics are started. Imaging to identify a source must likewise not delay antimicrobials. Taking culture after antibiotics is inferior when immediate pre-treatment sampling is feasible.

Reference: NICE. Suspected sepsis in under 16s: recognition, diagnosis and early management (NG254), Managing suspected sepsis, recommendations 1.7.1–1.7.7. 2025. https://www.nice.org.uk/guidance/NG254/chapter/managing-suspected-sepsis