Introduction and Project Overview
Globally, sepsis is the primary cause of mortality among infants. Based on expert opinion, the current pediatric-specific criteria for sepsis were published in 2005. Children were not included in the 2016 Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) that defined sepsis as organ dysfunction that is life-threatening and is caused by an aberrant host response to an infection. The Phoenix sepsis criteria for sepsis and septic shock in children were developed and confirmed by the international SCCM Pediatric Sepsis Definition Task Force using a comprehensive international database and survey, systematic review and meta-analysis, and a modified Delphi consensus approach. Its implementation can enhance clinical care, epidemiological evaluation, and research in the field of pediatric sepsis and septic shock globally.
Criteria for Pediatric Sepsis: A Historic Perspective Provided by Systematic Review
This systematic review examined the link between individual variables and sepsis development in children with infections and mortality odds. Despite clinical heterogeneity and limited studies, strong associations were found for many variables, primarily reflecting organ dysfunction, supporting their inclusion in the Pediatric Sepsis Definition Taskforce.
What Pediatric Clinicians Expect in a Pediatric Sepsis Definition?
It was concluded that the international community of clinicians who care for children with life-threatening infections does have limitations on the availability of diagnostic and therapeutic resources. However, vital sign measurement and basic laboratory testing are frequently available. The community perceives current sepsis definitions to be inadequate for use across the spectrum of need (e.g. recognition, quality benchmarking, research), hence need a set of definitions that does it all. Therefore, data for definitions which are pediatric-specific and broadly applicable across resource settings were accepted.
Development and Validation of the Phoenix Pediatric Sepsis Criteria
A novel score, the Phoenix Sepsis Score, was developed and validated in this international, multicenter, retrospective cohort study encompassing over 3.6 million pediatric encounters. A 4-organ-system model, the Phoenix Sepsis Score, was found to be the most effective in predicting mortality in 172,984 children with suspected infection within 24 hours. Using a score of 2 points or higher for sepsis and septic shock improved predictive value and sensitivity compared to the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria. The score was utilized to forecast mortality in children who had either suspected or confirmed infection. In comparison to the IPSCC criteria and extant organ dysfunction scores, the performance of the newly established criteria for pediatric sepsis and septic shock was enhanced. This new data-driven criteria for pediatric sepsis and septic shock based on measures of organic dysfunction had improved performance compared with prior pediatric sepsis criteria.
Operationalizing a Sepsis Definition for Children: Think Globally but Act Locally
It was concluded that there are challenges and opportunities in operationalizing sepsis in the global and diverse settings in which children present, but any criteria developed must be applicable locally to identify, manage, and study children presenting sepsis. Criteria need to be unambiguous yet flexible, capable of adapting to the widely different contexts in which children with suspected infection present, so they can be implemented locally.
Society of Critical Care Medicine’s Critical Care Congress (SCCM 2024), Phoenix, Arizona, USA, Jan 21-23, 2024
