The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force developed the Phoenix Sepsis Score to aid in the diagnosis of pediatric sepsis and septic shock. The authors are from multiple institutions from around the world.
Patient selection: pediatric from 0 to 17 years
Organ system subscores:
(1) points for respiratory status
(2) points for cardiovascular status
(3) points for coagulation status
(4) points for neurological status
Parameters:
(1) PaO2 to FIO2 ratio or SpO2 to FIO2 ratio
(2) respiratory support
(3) number of vasoactive medications
(4) blood lactate in mmol/L
(5) mean arterial pressure in mm Hg
(6) platelet count per microliter
(7) INR
(8) plasma D-dimer in mg/L FEU
(9) plasma fibrinogen in mg/dL
(10) Glasgow coma scale (GCS)
(11) pupillary response to light
|
PaO2 to FIO2 (SpO2 to FIO2) |
Respiratory Support |
Points for Respiratory Status |
|
>= 400 (>= 292) |
NA |
0 |
|
201 to 399 (221 to 291) |
any |
1 |
|
100 to 200 (148 to 220) |
invasive mechanical |
2 |
|
< 100 (< 148) |
invasive mechanical |
3 |
|
Cardiovascular Parameter |
Finding |
Points |
|
vasoactive drugs |
none |
0 |
|
|
1 |
1 |
|
|
>= 2 |
2 |
|
blood lactate |
< 5 mmol/L |
0 |
|
|
5 to 10.9 mmol/L |
1 |
|
|
>= 11 mmol/L |
2 |
|
mean arterial pressure |
|
< see following table> |
|
Age in Months |
Mean Arterial Pressure |
Points |
|
< 1 month |
> 30 mm Hg |
0 |
|
|
17 to 30 |
1 |
|
|
< 17 |
2 |
|
1 to 11 months |
> 38 mm Hg |
0 |
|
|
25 to 38 |
1 |
|
|
< 25 |
2 |
|
1 to 1.99 years |
> 43 mm Hg |
0 |
|
|
31 to 43 |
1 |
|
|
< 31 |
2 |
|
2 to 4.99 years |
> 44 mm Hg |
0 |
|
|
32 to 44 |
1 |
|
|
< 32 |
2 |
|
5 to 11.99 years |
> 48 mm Hg |
0 |
|
|
36 to 48 |
1 |
|
|
< 36 |
2 |
|
12 to 17 years |
> 51 mm Hg |
0 |
|
|
38 to 51 |
1 |
|
|
<38 |
2 |
subscore for cardiovascular status =
= MIN(6, SUM(points for all 3 parameters)
|
Coagulation Parameter |
Finding |
Points |
|
platelet count |
>= 100,000 per µL |
0 |
|
|
< 100,000 per µL |
1 |
|
INR |
<= 1.3 |
0 |
|
|
> 1.3 |
1 |
|
D-dimer |
<= 2 mg/L FEU |
0 |
|
|
> 2 mg/L FEU |
1 |
|
fibrinogen |
>= 100 mg/dL |
0 |
|
|
< 100 mg/dL |
1 |
subscore for coagulation =
= MIN(2, SUM(points for all 4 parameters)
|
Pupillary Response |
GCS |
Points for Neurologic Status |
|
fixed bilaterally |
NA |
2 |
|
one or both reactive |
<= 10 |
1 |
|
reactive |
11 to 15 |
0 |
total score =
= SUM(points for respiratory status) + (points for cardiovascular status) + (points for coagulation) + (points for neurologic status)
Interpretation:
• minimum score: 0
• maximum score: 13
• Sepsis was defined as a score >= 2 in a patient with suspected infection.
• Septic shock was defined as score >=2 with cardiovascular score >= 1.
Performance:
• The area under the ROC curve ranged from 071 to 0.92 for predicting mortality.
Specialty: Infectious Diseases
