Two major publications in the Journal of the American Medical Association (JAMA) have been released International Consensus Criteria for Pediatric Sepsis and Septic Shock and Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock detailing the efforts of an international team of researchers to modernize and improve on the diagnostic criteria for pediatric sepsis. I am fortunate to have been part of this team and co-second author on the “Development” manuscript, and co-author on the consensus manuscript.
These publications report on the development and consensus for the Phoenix Sepsis Score as the new diagnostic criteria for pediatric sepsis and septic shock. The publication coincides with the criteria being presented at the 2024 Critical Care Congress of the Society for Critical Care Medicine (SCCM)
The Phoenix criteria will be utilized for diagnosing pediatric sepsis and septic shock in children all over the world.
The big picture
Globally, pediatric sepsis is responsible for an estimated 3.3 million deaths per year.
Prior to 2016, the diagnostic criteria for both adult and pediatric sepsis was based on an inflammatory response. That criteria had low sensitivity and was difficult to implement across differently resourced medical facilities. In 2016 the diagnostic criteria for adult sepsis was redefined based on life-threatening organ dysfunction. The publication of the Phoenix criteria in 2024 brings the diagnostic criteria for pediatric sepsis in-line with the adult sepsis definition as both are now based on life-threatening organ dysfunction. Additionally, the Phoenix criteria was developed to be useful in high- and low-resourced environments, that is, the criteria is applicable across the globe, in major metropolitan area research hospitals and rural medical clinics.
How was the Phoenix Criteria Developed
Data from hospital systems in North America, Asia, Africa, and South America, were collected and harmonized into one analysis set of more than 3 million patient encounters. A data-informed Delphi process was used to identify the most useful existing organ dysfunction scoring systems. The term “useful” means that the scoring system preformed well in estimating risk of death in statistical models, but was a reasonable scoring system to use world-wide. For example, a score that considers a specific and expensive laboratory test would not be considered useful since it is unlikely to be available in middle- or low- resourced environments, even if that test was extremely good at predicating mortality in statistical models.
After a set of useful organ dysfunction scores were identified, stacked regression methods were used to test different combinations of the scores for predicting mortality. Finally, a set of organ dysfunction scores were selected by the Delphi-process and the Phoenix Criteria was established.
The Phoenix Criteria
The reader is encouraged to reference the published papers for all the details.
The Phoenix criteria is based on dysfunction in four organ systems
- respiratory,
- cardiovascular,
- coagulation, and
- neurologic.
Points are given based on the level of dysfunction in each of the systems. 0-3 points for respiratory, 0-6 points for cardiovascular, 0-2 points for coagulation, and 0-2 points for neurologic. A total score of 2 or more points is the diagnostic criteria for sepsis, and a total score of 2 or more points with at least one point in the cardiovascular system is the diagnostic criteria for septic shock.
Note: An extended scoring system using eight organ systems, the four listed above along with endocrine, immunologic, renal, and hepatic, has been published too.
Links to the Manuscripts:
Other links and news posts about this work:
CU Researchers Unveil Modernized Criteria For Pediatric Sepsis and Septic Shock
YouTube video of the presentation to SCCM: Announcement of the Novel Phoenix Pediatric Sepsis Criteria
R package, Python Module, and SQL for applying the Phoenix criteria to data sets: