CLINICAL QUESTION: Which screening tool performs best for early prediction of sepsis and septic shock in children per the Phoenix criteria?
BACKGROUND: Early recognition of sepsis remains challenging given heterogeneity in presentation. Existing screening tools have not yet been validated as defined by the recently developed Phoenix sepsis criteria.
STUDY DESIGN: Retrospective cohort study
SETTING: Single-center pediatric emergency department
SYNOPSIS: Among more than 47,000 patients with suspected infection, performance characteristics of qPS4, LqSOFA, and CHOP sepsis screening tools were compared for identifying patients meeting Phoenix criteria for sepsis or septic shock within 24 hours. Overall, qPS4 yielded the highest sensitivity, particularly in older age groups in which sepsis prevalence was higher. Moreover, qPS4 predicted sepsis (with or without shock) soonest, with a median, early-warning, lead time of 1.9 hours prior to fulfillment of Phoenix sepsis diagnostic criteria. However, qPS4 had slightly lower specificity, and all three tools demonstrated poor positive predictive value. Screening showed similar patterns in predicting septic shock, but with higher sensitivity and longer early warning lead-time.
BOTTOM LINE: qPS4 demonstrates superiority for predicting Phoenix sepsis and septic shock, although results were suboptimal in younger infants. Low positive predictive value highlights the importance of a “diagnostic pause” in situations of ambiguity and still obliges shrewd clinical judgment.
CITATION: Georgette N, et al. Comparing screening tools for predicting Phoenix criteria sepsis and septic shock among children. Pediatrics. 2025;155(5):e2025071155. doi: 10.1542/peds.2025- 071155.
Dr. Lammers
Dr. Lammers is a pediatric infectious disease and pediatric hospital medicine fellow at Nationwide Children’s Hospital in Columbus, Ohio.
Dr. Earl
Dr. Earl is an internal medicine and pediatric hospitalist at The Ohio State University Wexner Medical Center and Nationwide Children’s Hospital and an assistant professor of internal medicine and pediatrics at The Ohio State University College of Medicine, all in Columbus, Ohio
