Rethinking Pediatric Sepsis

Reference: Sanchez-Pinto, L.N., et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA 2024​​. Guest Skeptic: Prof. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Professor for the University of Leicester’s SAPPHIRE group. He specializes in Paediatric Emergency Medicine and is a passionate believer and advocate of FOAMed. Damian is also part of the Don’t Forget the Bubbles Team. Dr. Damian Roland Case: A 3-year-old boy arrives at the emergency department (ED) with a high fever, rapid breathing, and lethargy. His parents state that he has had a fever and cough for the past three days. He tested positive for influenza two days ago but seems to be getting worse. On exam, he has crackles in his right lung field. His pulse oximeter reads 88% on room air. His heart rate is elevated. He looks sleepy but is clinging to his parents. A medical trainee you are working with asks, “He looks really sick. Is this pneumonia or could this be sepsis?” Background: Pediatric sepsis is a major global health concern, causing an estimated 3.3 million deaths annually. The 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria were established based on expert consensus and used for diagnosis. However, they've been criticized for low specificity and not being adaptable across different resource settings​​. The SGEM has covered sepsis multiple times:  SGEM #448: More than a Feeling-Gestalt vs CDT for Predicting Sepsis SGEM #371: All of My Lovit, Vitamin C Won’t Work for You SGEM #346: Sepsis-You were Always on My Mind SGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines SGEM #207: Ahh (Don’t) Push It- Pre-hospital IV Antibiotics for Sepsis SGEM #174: Don’t Believe the Hype - Vitamin C Cocktail for Sepsis SGEM #168: HYPRESS - Doesn’t got the Power SGEM #92: Arise Up, Arise Up (EGDT vs Usual Care for Sepsis) SGEM #90: Hunting High and Low (Best MAP for Sepsis Patients) SGEM #69: Cry Me a River (Early Goal-Directed Therapy) Process Trial Today we’re covering the newest criteria, the Phoenix Criteria, for the diagnosis of pediatric sepsis and septic shock. It is more evidence-based and incorporates data from high and low-resource settings.  Clinical Question: How accurately can a new clinical decision rule (The Phoenix Sepsis Score) diagnose pediatric sepsis and septic shock in hospitalized children within the first 24 hours? Reference: Sanchez-Pinto, L.N., et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA 2024​​. Population: Children less than 18 years of age with suspected sepsis and septic shock who were admitted to one of ten hospitals in five countries. Exclusions: Newborns and children with postconceptional age of <37 weeks Intervention: The Phoenix Criteria, which is a scoring system based on clinical signs, symptoms, and laboratory values. Comparison: International Pediatric Sepsis Consensus Conference (IPSCC) criteria Outcome: Primary Outcome: In-hospital mortality Secondary Outcomes: Composite of early death (within 72 hours of presentation) and requirement for extracorporeal membrane oxygenation (ECMO). For the Phoenix Scoring System, they used the area under the receiver operating characteristic curve (AUROC) and for binary criteria, positive predictive value (PPV) and sensitivity.  Trial: Multicenter, retrospective cohort study Dr. Elizabeth Alpern Guest Authors: Dr. Elizabeth Alpern is a Professor of Emergency Medicine and Chief of Emergency Medicine at Lurie Children’s Hospital of Chicago and Vice Chair of Pediatrics at Northwestern University Feinberg School of Medicine. She’s also a clinical epidemiologist and expert in large databases including the PECARN registry. Dr. Halden Scott is an Associate Professor of Pediatrics at the University...