Multicenter Study

. 2025 Mar 3;8(3):e251412.

doi: 10.1001/jamanetworkopen.2025.1412.

External Validation of the Phoenix Sepsis Score in Children With Suspected Community-Acquired Sepsis

Elliot Long^{1

2

3

4}, Meredith L Borland^{5

6}, Shane George^{7

8

9}, Shefali Jani^{10

11}, Eunicia Tan^{12

13}, Natalie Phillips^{14

15}, Amit Kochar^{16

17}, Simon Craig^{2

18

19}, Anna Lithgow²⁰, Arjun Rao^{21

22}, Stuart Dalziel^{13

23}, Ed Oakley^{1

2

3

4}, Stephen Hearps^{2

4}, Ben Gelbart^{2

4

24}, Sarah McNab^{2

3

25}, Fran Balamuth^{26

27}, Scott L Weiss²⁸, Nathan Kuppermann²⁹, Charlotte Brad², Amanda Williams², Franz E Babl^{1

2

3

4}; Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network

Collaborators, Affiliations

Collaborators

Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network:
Catherine L Wilson Ms

Affiliations

¹ Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
² Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
⁴ Department of Critical Care, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
⁵ Department of Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁶ Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁷ Department of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Southport, Queensland, Australia.
⁸ School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
⁹ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Department of Emergency Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹¹ Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
¹² Middlemore Hospital, Aukland, New Zealand.
¹³ Department of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.
¹⁴ Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
¹⁵ Child Health Research Centre, University of Queensland, Queensland, Australia.
¹⁶ Department of Emergency Medicine, Women and Children's Hospital, Adelaide, South Australia, Australia.
¹⁷ Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.
¹⁸ Paediatric Emergency Department, Monash Medical Centre, Monash Health, Victoria, Australia.
¹⁹ Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
²⁰ Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
²¹ Department of Emergency Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.
²² School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia.
²³ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
²⁴ Paediatric Intensive Care Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.
²⁵ Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
²⁶ Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia.
²⁷ Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
²⁸ Nemours Children's Health and Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
²⁹ Departments of Pediatrics and Emergency Medicine, the George Washington School of Medicine and Health Sciences, and Children's National Hospital, Washington, DC.

PMID: 40116825
PMCID: PMC11929021
DOI: 10.1001/jamanetworkopen.2025.1412

Multicenter Study

External Validation of the Phoenix Sepsis Score in Children With Suspected Community-Acquired Sepsis

Elliot Long et al. JAMA Netw Open. 2025.

. 2025 Mar 3;8(3):e251412.

doi: 10.1001/jamanetworkopen.2025.1412.

Authors

Collaborators

Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network:
Catherine L Wilson Ms

Affiliations

¹ Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
² Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
⁴ Department of Critical Care, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
⁵ Department of Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁶ Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁷ Department of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Southport, Queensland, Australia.
⁸ School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
⁹ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Department of Emergency Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹¹ Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
¹² Middlemore Hospital, Aukland, New Zealand.
¹³ Department of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.
¹⁴ Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
¹⁵ Child Health Research Centre, University of Queensland, Queensland, Australia.
¹⁶ Department of Emergency Medicine, Women and Children's Hospital, Adelaide, South Australia, Australia.
¹⁷ Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.
¹⁸ Paediatric Emergency Department, Monash Medical Centre, Monash Health, Victoria, Australia.
¹⁹ Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
²⁰ Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
²¹ Department of Emergency Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.
²² School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia.
²³ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
²⁴ Paediatric Intensive Care Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.
²⁵ Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
²⁶ Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia.
²⁷ Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
²⁸ Nemours Children's Health and Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
²⁹ Departments of Pediatrics and Emergency Medicine, the George Washington School of Medicine and Health Sciences, and Children's National Hospital, Washington, DC.

PMID: 40116825
PMCID: PMC11929021
DOI: 10.1001/jamanetworkopen.2025.1412

Abstract

Importance: The novel Phoenix Sepsis Score and sepsis criteria were derived and validated using a multicountry dataset and proposed as a new definition for sepsis in children.

Objective: To externally validate the Phoenix Sepsis Score and sepsis criteria in a cohort of children hospitalized with suspected community-acquired sepsis.

Design, setting, and participants: This diagnostic study used data from the multicenter, multicountry Sepsis Epidemiology in Australian and New Zealand Emergency Departments (SENTINEL) study, collected from 2021 to 2023 and including 90-day follow-up. Children admitted to the hospital through 11 emergency departments in Australia and New Zealand and treated with parenteral antibiotics with either (1) a provisional diagnosis of sepsis or (2) treatment for sepsis (intravenous fluid bolus to treat poor perfusion) were included.

Exposure: Development of organ dysfunction over the first 24 hours of hospitalization.

Main outcomes and measures: The main outcomes were (1) in-hospital mortality and (2) death or requirement for extracorporeal life support (ECLS) within 72 hours of hospitalization.

Results: A total of 6232 children were included in the analysis, with a median (IQR) age of 2.1 (0.3-7.1) years, 3386 (54.1%) male, in-hospital mortality of 60 (1.0%), and death or ECLS within 72 hours in 36 (0.6%). In this population, the worst Phoenix Sepsis Score calculated over the first 24 hours of hospitalization had an area under the precision recall curve of 0.17 (95% CI, 0.07-0.28) for predicting in-hospital mortality and 0.23 (95% CI, 0.11-0.36) for predicting death or ECLS within 72 hours. Overall, 306 children (4.9%) met the Phoenix sepsis criteria, of whom 33 (10.8%) died in the hospital (nearly half of the total number who died) and 28 (9.2%) died or required ECLS within 72 hours. The Phoenix sepsis criteria had a sensitivity of 55.0% (95% CI, 41.6%-67.9%) and positive predictive value (PPV) of 10.8% (95% CI, 7.6%-14.9%) for in-hospital mortality and sensitivity of 77.8% (95% CI, 60.8%-89.9%) and PPV of 9.2% (95% CI, 6.2%-13.0%) for death or ECLS within 72 hours. Coagulation data for the calculation of the Phoenix Sepsis Score were missing in more than 85% of children.

Conclusions and relevance: In this multicenter diagnostic study of children hospitalized with suspected sepsis, the Phoenix Sepsis Score and sepsis criteria had similar performance to the original derivation and validation cohorts. The small proportion of children meeting Phoenix sepsis criteria, missingness of data, timing of application, and lack of sensitivity for in-hospital mortality limit the clinical utility of the criteria.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dalziel reported receiving grants from Cure Kids New Zealand during the conduct of the study. Dr Balamuth reported receiving grants from the National Institutes of Health and Children’s Hospital of Philadelphia for connected clinical trial PROMPT BOLUS during the conduct of the study. Dr Kuppermann reported receiving grants from the National Institutes of Health and the Health Resources and Services Administration outside the submitted work. Dr Babl reported grants from The National Health and Medical Research Foundation (NHMRC) and the Medical Research Futures Fund (MRFF) during the conduct of the study and an NHMRC leadership grant to the Royal Children Hospital Foundation outside the submitted work. No other disclosures were reported.

Figures

**Figure 1.. Flow Diagram of Included Participants**
ED indicates emergency department.

**Figure 2.. In-Hospital Mortality Associated With the Phoenix Sepsis Score in Patients With Suspected Community-Acquired Sepsis**
Bar indicates the median and whiskers the 95% CI.

See this image and copyright information in PMC

References

1. Rudd KE, Johnson SC, Agesa KM, et al. . Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211. doi:10.1016/S0140-6736(19)32989-7 - DOI - PMC - PubMed
1. Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis . International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8. doi:10.1097/01.PCC.0000149131.72248.E6 - DOI - PubMed
1. Scott HF, Deakyne SJ, Woods JM, Bajaj L. The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department. Acad Emerg Med. 2015;22(4):381-389. doi:10.1111/acem.12610 - DOI - PubMed
1. Schlapbach LJ, Weiss SL, Bembea MM, et al. ; Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative . Scoring systems for organ dysfunction and multiple organ dysfunction: the PODIUM Consensus Conference. Pediatrics. 2022;149(1)(suppl 1):S23-S31. doi:10.1542/peds.2021-052888D - DOI - PMC - PubMed
1. Sanchez-Pinto LN, Bennett TD, DeWitt PE, et al. ; Society of Critical Care Medicine Pediatric Sepsis Definition Task Force . Development and validation of the Phoenix criteria for pediatric sepsis and septic shock. JAMA. 2024;331(8):675-686. doi:10.1001/jama.2024.0196 - DOI - PMC - PubMed

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External Validation of the Phoenix Sepsis Score in Children With Suspected Community-Acquired Sepsis

Collaborators

Affiliations

External Validation of the Phoenix Sepsis Score in Children With Suspected Community-Acquired Sepsis

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous