TY - JOUR
T1 - Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock
AU - Sanchez-Pinto, L. Nelson
AU - Bennett, Tellen D.
AU - Dewitt, Peter E.
AU - Russell, Seth
AU - Rebull, Margaret N.
AU - Martin, Blake
AU - Akech, Samuel
AU - Albers, David J.
AU - Alpern, Elizabeth R.
AU - Balamuth, Fran
AU - Bembea, Melania
AU - Chisti, Mohammod Jobayer
AU - Evans, Idris
AU - Horvat, Christopher M.
AU - Jaramillo-Bustamante, Juan Camilo
AU - Kissoon, Niranjan
AU - Menon, Kusum
AU - Scott, Halden F.
AU - Weiss, Scott L.
AU - Wiens, Matthew O.
AU - Zimmerman, Jerry J.
AU - Argent, Andrew C.
AU - Sorce, Lauren R.
AU - Schlapbach, Luregn J.
AU - Watson, R. Scott
AU - Biban, Paolo
AU - Carrol, Enitan
AU - Chiotos, Kathleen
AU - Flauzino De Oliveira, Claudio
AU - Hall, Mark W.
AU - Inwald, David
AU - Ishimine, Paul
AU - Levin, Michael
AU - Lodha, Rakesh
AU - Nadel, Simon
AU - Nakagawa, Satoshi
AU - Peters, Mark J.
AU - Randolph, Adrienne G.
AU - Ranjit, Suchitra
AU - Souza, Daniela Carla
AU - Tissieres, Pierre
AU - Wynn, James L.
N1 - Publisher Copyright:
© 2024 American Medical Association. All rights reserved.
PY - 2024/2/27
Y1 - 2024/2/27
N2 - Importance: The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force sought to develop and validate new clinical criteria for pediatric sepsis and septic shock using measures of organ dysfunction through a data-driven approach. Objective: To derive and validate novel criteria for pediatric sepsis and septic shock across differently resourced settings. Design, Setting, and Participants: Multicenter, international, retrospective cohort study in 10 health systems in the US, Colombia, Bangladesh, China, and Kenya, 3 of which were used as external validation sites. Data were collected from emergency and inpatient encounters for children (aged <18 years) from 2010 to 2019: 3049699 in the development (including derivation and internal validation) set and 581317 in the external validation set. Exposure: Stacked regression models to predict mortality in children with suspected infection were derived and validated using the best-performing organ dysfunction subscores from 8 existing scores. The final model was then translated into an integer-based score used to establish binary criteria for sepsis and septic shock. Main Outcomes and Measures: The primary outcome for all analyses was in-hospital mortality. Model- and integer-based score performance measures included the area under the precision recall curve (AUPRC; primary) and area under the receiver operating characteristic curve (AUROC; secondary). For binary criteria, primary performance measures were positive predictive value and sensitivity. Results: Among the 172984 children with suspected infection in the first 24 hours (development set; 1.2% mortality), a 4-organ-system model performed best. The integer version of that model, the Phoenix Sepsis Score, had AUPRCs of 0.23 to 0.38 (95% CI range, 0.20-0.39) and AUROCs of 0.71 to 0.92 (95% CI range, 0.70-0.92) to predict mortality in the validation sets. Using a Phoenix Sepsis Score of 2 points or higher in children with suspected infection as criteria for sepsis and sepsis plus 1 or more cardiovascular point as criteria for septic shock resulted in a higher positive predictive value and higher or similar sensitivity compared with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria across differently resourced settings. Conclusions and Relevance: The novel Phoenix sepsis criteria, which were derived and validated using data from higher- and lower-resource settings, had improved performance for the diagnosis of pediatric sepsis and septic shock compared with the existing IPSCC criteria..
AB - Importance: The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force sought to develop and validate new clinical criteria for pediatric sepsis and septic shock using measures of organ dysfunction through a data-driven approach. Objective: To derive and validate novel criteria for pediatric sepsis and septic shock across differently resourced settings. Design, Setting, and Participants: Multicenter, international, retrospective cohort study in 10 health systems in the US, Colombia, Bangladesh, China, and Kenya, 3 of which were used as external validation sites. Data were collected from emergency and inpatient encounters for children (aged <18 years) from 2010 to 2019: 3049699 in the development (including derivation and internal validation) set and 581317 in the external validation set. Exposure: Stacked regression models to predict mortality in children with suspected infection were derived and validated using the best-performing organ dysfunction subscores from 8 existing scores. The final model was then translated into an integer-based score used to establish binary criteria for sepsis and septic shock. Main Outcomes and Measures: The primary outcome for all analyses was in-hospital mortality. Model- and integer-based score performance measures included the area under the precision recall curve (AUPRC; primary) and area under the receiver operating characteristic curve (AUROC; secondary). For binary criteria, primary performance measures were positive predictive value and sensitivity. Results: Among the 172984 children with suspected infection in the first 24 hours (development set; 1.2% mortality), a 4-organ-system model performed best. The integer version of that model, the Phoenix Sepsis Score, had AUPRCs of 0.23 to 0.38 (95% CI range, 0.20-0.39) and AUROCs of 0.71 to 0.92 (95% CI range, 0.70-0.92) to predict mortality in the validation sets. Using a Phoenix Sepsis Score of 2 points or higher in children with suspected infection as criteria for sepsis and sepsis plus 1 or more cardiovascular point as criteria for septic shock resulted in a higher positive predictive value and higher or similar sensitivity compared with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria across differently resourced settings. Conclusions and Relevance: The novel Phoenix sepsis criteria, which were derived and validated using data from higher- and lower-resource settings, had improved performance for the diagnosis of pediatric sepsis and septic shock compared with the existing IPSCC criteria..
UR - http://www.scopus.com/inward/record.url?scp=85182871056&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85182871056&partnerID=8YFLogxK
U2 - 10.1001/jama.2024.0196
DO - 10.1001/jama.2024.0196
M3 - Article
C2 - 38245897
AN - SCOPUS:85182871056
SN - 0098-7484
VL - 331
SP - 675
EP - 686
JO - JAMA
JF - JAMA
IS - 8
ER -