News: New pediatric sepsis criteria created through cohort study

The Society of Critical Care Medicine (SCCM) Pediatric Sepsis Definition Task Force has recently created the Phoenix Sepsis Score after conducting a retrospective cohort study published in JAMA. In an effort to develop and validate new clinical criteria for pediatric sepsis and septic shock through a data-driven approach, task force members looked at nearly 173,000 children from multiple countries with suspected infection in their first 24 hours of care in an emergency and inpatient counter, MedPage Today reported.

The score is a four organ system model that includes criteria for respiratory, cardiovascular, coagulation, and neurologic dysfunction, ultimately using “an infection with life-threatening organ dysfunction” as a conceptual definition for sepsis. When task force members used a Phoenix Sepsis Score of two points or higher for children with suspected infection as criteria for sepsis and sepsis plus one or more cardiovascular points as criteria for septic shock, they saw a higher positive predictive value and better or similar sensitivity compared with using the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria.

“New pediatric sepsis criteria should maximize identification of true-positive cases so that infected children with life-threatening organ dysfunction receive best-practice sepsis care, are appropriately enrolled in clinical studies, and are correctly represented in epidemiological surveillance,” they wrote. “Simultaneously, new criteria must minimize false-positive cases so that children are not misdiagnosed with sepsis. This is important to reduce unnecessary use of antimicrobials and other treatments, optimize the efficiency of clinical studies, and avoid overcounting in surveillance.”

An accompanying JAMA study posting survey data shows that when using the Phoenix Sepsis Score criteria, patients with a score of two or higher had an in-hospital mortality rate of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than eight times that of those with suspected infection not meeting these criteria. The in-hospital mortality rate of patients who were in septic shock as defined by this new criteria was 10.8% in higher-resource settings and 33.5% in lower-resource settings.

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the JAMA study’s findings, click here.