In February this year, the international Society of Critical Care Medicine and the European Society of Intensive Care Medicine Pediatric Sepsis Definition Task Force released the Phoenix criteria for sepsis and sepsis shock in children (read more here and here). These new criteria incorporate organ dysfunction scores for the respiratory, cardiovascular, coagulation, and/or neurological systems and enable clinicians to better identify children with suspected infection at higher risk of mortality. Key advantages include:
- Improved Accuracy & Enhanced Identification: The Phoenix sepsis criteria provide a more accurate and clinically-relevant definition of sepsis and septic shock compared to the 2005 International Pediatric Sepsis Consensus Conference criteria, which was based on systematic inflammatory response syndrome (which is not indicative of poor outcomes), inconsistently applied by clinicians and researchers, and not data-driven.
- Global Applicability: The new criteria were developed and validated using data from both high and lower-resource settings and includes redundant variables so that children with sepsis and septic shock can be identified and managed effectively across different health systems, clinical settings, and geographic locations.
- Standardized Framework: The criteria will facilitate harmonized data collection on epidemiology of disease globally and support clinical care, quality improvement, benchmarking, and research to improve outcomes for children with sepsis.
How were these criteria created?
The Phoenix sepsis criteria is the culmination of a five year effort, starting with the Pediatric Sepsis Definition Task Force conducting a global survey of 2,835 health care providers to characterize the use and applicability of different criteria to diagnose sepsis and septic shock in children. The Task Force then conducted a systematic review and meta-analysis to identify organ dysfunction scores associated with death from severe infections and led a data-driven derivation and validation study and modified Delphi consensus process to identify which organ dysfunction scores and thresholds to include in the final criteria for defining sepsis. Each step included data from lower- and higher-resource settings and considered the challenges related to limited resources.
"For the first time, we have criteria for pediatric sepsis that can be applied across
global settings and improve the outcomes of children worldwide." -Dr. Matthew Wiens
Future research is still needed to develop screening and early warning tools that correctly identify children at risk for sepsis and guide earlier treatment and interventions. In addition, challenges remain in implemented the new criteria, particularly in lower-resource settings where the health workforce and laboratory resources are limited and the disease burden is highest. However, use of the criteria has significant potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock globally, particularly when coupled with the increasing digitization of health systems in resource-limited settings.
About the Task Force
This task force consists of 35 nurses and physicians from a globally representative set of countries and medical disciplines involved in pediatric sepsis care. This diversity in representation of expertise and health systems has been crucial in ensuring a comprehensive and global perspective in developing the Phoenix sepsis criteria. Cluster members Dr. Matthew Wiens, Assistant Professor in the Department of Anesthesiology, Pharmacology & Therapeutics at UBC, and Dr. Niranjan ‘Tex’ Kissoon, Professor in the Department of Pediatrics at UBC, both contributed to the task force.