Global Group of Researchers Release New Criteria for Diagnosing Pediatric Sepsis and Septic Shock

Children who meet the new criteria for sepsis diagnosis may face an 8x higher risk of death than children with suspected sepsis, who do not match the new guidelines.

An international team of researchers is introducing new criteria to help better identify and treat children with suspected sepsis.

The new guidelines were established by the Society of Critical Care Medicine’s task force and published in the Journal of the American Medical Association (JAMA) on January 21, together with a presentation of the criteria this week at the 2024 Critical Care Congress of the Society for Critical Care Medicine.

Sepsis is a life-threatening condition that occurs when an individual’s immune system has a dangerous response to an infection and starts to damage the body’s tissues and organs. Symptoms of the condition include decreased blood pressure, increased heart rate, fever, confusion, shortness of breath, weakness, and can result in organ failure or death.

The Society of Critical Care Medicine convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from six continents to recommend a new set of guidelines on how to treat children under 18 years old with suspected sepsis and a higher risk of death.

The team, led by researchers at the University of Colorado School of Medicine, conducted a systematic review and analysis of more than 3 million pediatric health care encounters from 10 medical sites across four continents.

The task force recommended defining sepsis in children as infections identified by two points using the Phoenix Sepsis Score, which includes identifying dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems.

The review indicates children with at least two points on the sepsis score had a 7% increased risk of death in the hospital if they were treated in higher resource settings and a 29% increased risk if they were treated in lower resource hospitals. This risk of death was eight times higher than among children with suspected infections who do not meet the new sepsis criteria.

Children with septic shock had an 11% increased risk of death in higher resource hospitals and a 34% increased risk of death if they were treated in lower-resource hospitals.

Death rates were also higher among children with organ dysfunction in the respiratory, cardiovascular, coagulation, or neurological organ systems.

New Pediatric Sepsis Criteria

Prior to the new criteria, most doctors defined sepsis as an infection with life-threatening organ dysfunction that can lead to death.

With the new criteria, septic shock is defined as children with sepsis who had cardiovascular dysfunction with at least one cardiovascular point on the Phoenix Sepsis Score.

The new criteria updates sepsis definitions first established in 2005 and later defined as a life-threatening infection in 2016. However, those criteria did not include children and left many to suffer untreated sepsis, since there was no agreed consensus as to when to diagnose it and how to treat it, because a child’s body responds to sepsis in a different way than adults.

Adults can often have a drop in blood pressure early on, but children maintain blood pressure much longer, but can experience severe symptoms in a different way. Children suffering from sepsis or septic shock can experience damage to the kidneys, lungs, heart, and brain, as well as death, if the condition is not treated quickly and appropriately.

Researchers said the new Phoenix Sepsis Score criteria “has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.”