January 22, 2024
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Key takeaways:
- The Society of Critical Care Medicine published the first new criteria for diagnosing pediatric sepsis in nearly 20 years.
- The “Phoenix criteria” uses measures of organ dysfunction to score sepsis risk.
Experts have published the first new criteria for diagnosing pediatric sepsis and septic shock since 2005.
Two investigations conducted by the Society of Critical Care Medicine’s Pediatric Sepsis Definition Task Force and presented at the 2024 Critical Care Congress in Phoenix resulted in the updated criteria, which use measures of organ dysfunction rather than systemic inflation to diagnose the syndrome.
Experts issued new criteria for diagnosing pediatric sepsis. Image: Adobe Stock
The newly named “Phoenix criteria” for pediatric sepsis and septic shock mirrors an updated definition of adult sepsis that was published in 2016.
“The last pediatric sepsis criteria were developed nearly 20 years ago and were based on expert opinion, whereas the new criteria we derived are based on data from electronic health records and analysis of more than 3 million pediatric health care encounters from 10 hospitals around the world, including in low-resource settings,” L. Nelson Sanchez-Pinto, MD, MBI, associate professor of pediatrics and preventive medicine at Northwestern University Feinberg School of Medicine and research scholar at Lurie Children’s Hospital of Chicago, said in a press release.
Sanchez-Pinto and colleagues assembled the criteria using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score, as well as international data from millions of health records.
“We leveraged a heavily data-driven approach in order to develop and validate these new criteria,” Tellen D. Bennett, MD, MS, a professor of biomedical informatics and pediatric critical care at the University of Colorado School of Medicine, said in a release.
The data used in updating the criteria are “representative of kids all over the world who are at risk for sepsis and have sepsis,” Bennett said. In addition to the United States, they studied data from sites in Bangladesh, China, Colombia, Kenya and elsewhere, totaling more than 3 million electronic health record encounters in 10 countries.
“We used robust machine-learning methods to analyze these data in order to provide crucial and reliable information to clinicians of every level of training, from the field worker in Africa to the physician or nurse at a high-resource ICU,” Bennett said.
“We used a machine learning approach to narrow down elements that were most effective in identifying children at high risk of dying from organ dysfunction in the setting of an infection,” Sanchez-Pinto said.
The researchers tested a four-organ-system model — dubbed the Phoenix Sepsis Score — among 172,984 children with suspected infections in the first 24 hours. The model assigns a score to sepsis risk, with a score of 2 or higher indicating a suspected infection as criteria for sepsis, plus one or more cardiovascular points as criteria for septic shock.
The new criteria rely on four systems: cardiovascular, respiratory, neurological and coagulation, according to authors. An integer version of the model identified area under the precision recall curves of 0.23 to 0.38 (95% CI, 0.2-0.39) and area under the receiver operating characteristic curves of 0.71 to 0.92 (95% CI, 0.7-0.92)
“These criteria are better than the old ones at identifying children with infections at higher risk of poor outcomes and are globally applicable, including in low-resource settings,” Sanchez-Pinto said.
“We are actively working on clinical decision support tools for both higher and lower resource environments that will bring these new criteria to the bedside,” Bennett said. “My colleagues and I have deployed tools inside electronic health record systems before, and we plan to deploy this tool in such a way that it can be shared across different health systems.”
Two related editorials were published at the same time in JAMA, including one by Erin F. Carlton, MD, MSc, Mallory A. Perry-Eaddy, PhD, RN, and Hallie C. Prescott, MD, MSc.
“The Phoenix sepsis criteria identify children with life-threatening organ dysfunction in the setting of infection,” they wrote. “These new definitions and shared conceptual understanding of pediatric sepsis will support improvements in the management, research, and outcomes of children with sepsis worldwide.”
References:
Carlton EF, et al. JAMA. 2024;doi: 10.1001/jama.2023.27979.
CU researchers unveil modernized criteria for pediatric sepsis and septic shock. https://www.eurekalert.org/news-releases/1031921. Published Jan. 21, 2024. Accessed Jan. 21, 2024.
Jabornisky R, et al. JAMA. 2024;doi: 10.1001/jama.2023.27988.
New criteria for sepsis in children based on organ dysfunction. https://www.eurekalert.org/news-releases/1031801. Published Jan. 21, 2024. Accessed Jan. 21, 2024.
Sanchez-Pinto LN, et al. JAMA. 2024;doi: 10.1001/jama.2024.0196.
Schlapbach LJ, et al. JAMA. 2024;doi: 10.1001/jama.2024.0179.
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Sources/Disclosures
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Disclosures:
Bennett reports receiving grants from the NIH/National Center for Advancing Translational Sciences and NIH/National Heart, Lung, and Blood Institute outside the submitted work. Carlton reports serving on the Pediatric Surviving Sepsis Campaign Guideline committee, receiving grant support from the NIH. Perry-Eaddy reports receiving grant support from the NIH. Prescott reports serving as cochair of the Surviving Sepsis Campaign Adult Guidelines panel and receiving grant funding and/or salary support from the Agency for Healthcare Research and Quality, Blue Cross Blue Shield of Michigan, CDC, NIH, Veterans Affairs. Sanchez-Pinto reports receiving grants from the NIH/National Institute of General Medical Sciences outside the submitted work reports. Please see the studies and editorials for all other authors’ related financial disclosures.
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