Comparing Screening Tools for Predicting Phoenix Criteria Sepsis and Septic Shock among Children

BACKGROUND AND OBJECTIVES The Phoenix criteria for pediatric sepsis and septic shock have recently been proposed for worldwide application. The Phoenix sepsis criteria are based on organ dysfunction scoring. Although many screening tools exist, their performance in predicting Phoenix outcomes is not known. We hypothesized that the quick Pediatric Septic Shock Screening Score (qPS4) would demonstrate greater sensitivity compared with the Liverpool quick Sequential Organ Failure Assessment (LqSOFA) and a commonly used 2-stage screening tool created at Children’s Hospital of Philadelphia (CHOP). METHODS We performed a secondary analysis of the qPS4 validation set data from a retrospective cohort study of pediatric emergency department patients with suspected infection. The exposure was a positive screen prior to outcome occurring. We calculated the predictive characteristics of qPS4, LqSOFA, and CHOP for Phoenix sepsis and septic shock within 24 hours of arrival. RESULTS We analyzed 47 176 encounters. Within 24 hours of arrival to the ED, 628 (1.3%) met criteria for sepsis and 228 (0.5%) met criteria for septic shock. The qPS4 predicted sepsis with 67.8% sensitivity and 89.6% specificity compared with LqSOFA (sensitivity 47.0%, specificity 95.7%) and the CHOP screen (sensitivity 49.7%, specificity 92.1%) (P < .05 for all compared to qPS4). The qPS4 predicted septic shock with 85.5% sensitivity and 89.0% specificity compared with LqSOFA (sensitivity 59.2%, specificity 95.2%) and the 2-stage CHOP screen (sensitivity 64.9%, specificity 91.5%) (P < .05 for all compared to qPS4). CONCLUSIONS The qPS4 predicted Phoenix sepsis and septic shock with greater sensitivity and clinically similar specificity compared with widely used bedside tools.