Task Force Develops, Validates New Criteria for Diagnosing Pediatric Sepsis and Septic Shock
A novel, validated scoring system for identifying sepsis and septic shock in children younger than 18 years of age—the Phoenix Sepsis Score—should be used by physicians instead of the current pediatric-specific criteria for sepsis, according to an international task force.
Current pediatric-specific criteria for sepsis were last published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), and while the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) revised the definition of sepsis in 2016, this update only involved adults.
To fill this gap, the Society of Critical Care Medicine (SCCM) convened an international task force of 35 pediatric experts. The SCCM Pediatric Sepsis Definition Task Force used data from an international survey, systematic review and meta-analysis of more than 3 million pediatric health care encounters, and a modified Delphi consensus approach to develop the criteria for sepsis and septic shock in children.
“Based on survey data, most pediatric clinicians used ‘sepsis’ to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, ‘severe sepsis,’” the SCCM task force wrote in their study.
To validate the novel scoring system, the task force developed a multicenter, international, retrospective cohort study involving 10 health systems, three of which were used as external validation sites.
“The method used to develop the criteria leveraged knowledge gained by the Sepsis-3 process while incorporating novel elements, using a globally diverse task force and relying on data from diverse health care systems,” the authors wrote.
The task force found that using the Phoenix Sepsis Score will help physicians determine the severity of organ failure in children with sepsis. Among the notable revisions, the task force updated the IPSCC criteria, defining septic shock as “children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication.”
The SCCM task force also recommended that sepsis be identified by a Phoenix Sepsis Score of at least 2 points in those children or adolescents with “suspected infection, which indicates life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems.”
“These criteria may facilitate harmonized data collection on epidemiology of disease globally and may serve to support clinical care, quality improvement, benchmarking, and research to improve outcomes for children with sepsis,” the task force wrote.
Indeed, the task force found in their validation analysis that the Phoenix Sepsis Score threshold of at least 2 points had better predictive value and higher or similar sensitivity for in-hospital mortality in children with confirmed or suspected infection in the first 24 hours compared with the IPSCC definition of sepsis and severe sepsis.
The former IPSCC criteria should not be used to diagnose sepsis in children, the task force recommended. Additionally, the term “severe sepsis” should no longer be used because sepsis is a life-threatening organ dysfunction associated with infection and is thus indicative of a severe disease state.
“A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world,” the task force concluded.
Reference:
Schlapbach LJ, Watson RS, Sorce LR, et al. International consensus criteria for pediatric sepsis and septic shock. JAMA. 2024;331(8):665-674. doi:10.1001/jama.2024.0179