Updated pediatric sepsis definition could save countless children's lives

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An international research team led by Tell Bennett, MD, MS, professor of biomedical informatics and pediatric critical care at the University of Colorado School of Medicine, released new diagnostic criteria for sepsis in children this week, marking the first update to the pediatric sepsis definition in nearly two decades.

The updated criteria, presented at the 2024 Critical Care Congress of the Society for Critical Care Medicine (SCCM), will be utilized for diagnosing pediatric sepsis and septic shock in children all over the world.

"We leveraged a heavily data-driven approach in order to develop and validate these new criteria," says Bennett, who collaborated with nearly three dozen pediatric sepsis experts from around the world on a task force organized by SCCM.

The importance of defining pediatric sepsis

In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. The definition excluded children because their bodies respond to sepsis differently than adults – including how their immune systems attempt to fight off the infection and the way their physiology changes when they have organ dysfunction.

Many adults with sepsis, for example, experience a drop in blood pressure relatively early because of changes in the tone of the blood vessels, but children will maintain blood vessel tone much longer, and then hit a threshold of severity.

The SCCM task force aimed to bridge the gap between criteria in adults and children, and called for a data source that Bennett and his colleagues knew didn't exist. As a result, he and his colleagues obtained a grant to support acquiring pediatric sepsis data from 10 sites around the world. In addition to U.S. sites, the study included data from sites in Bangladesh, China, Colombia, and Kenya -; locations that are not consistently represented in international studies.

More children die from sepsis in lower resource settings, making it especially important to develop criteria that will be useful in all types of locations.

The data we used in updating these criteria is representative of kids all over the world who are at risk for sepsis and have sepsis. We used robust machine learning methods to analyze these data in order to provide crucial and reliable information to clinicians of every level of training, from the field worker in Africa to the physician or nurse at a high-resource ICU."

Tell Bennett, MD, MS, professor of biomedical informatics and pediatric critical care, University of Colorado School of Medicine

The updated criteria now includes measures of respiratory, cardiovascular, neurologic, and coagulation dysfunction. Researchers decided on the measures using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score based on over 3 million electronic health record encounters from the data sites in 10 countries and four continents.

In addition to being helpful in a medical clinic or hospital, the updated criteria will be significantly useful to medical researchers studying sepsis.

"It's important to have confidence in the integrity of the cohort of patients," Bennett says. "Otherwise, you might not be able to detect whether what you are studying is actually going to be helpful."

Developing tools to support the criteria

Now that researchers have built a new foundation with the diagnostic criteria, Bennett says there's already progress being made on developing tools that could be implemented into hospital care to monitor and diagnose pediatric sepsis.

"We are actively working on clinical decision support tools for both higher and lower resource environments that will bring these new criteria to the bedside," explains Bennett, who also serves as a colleague at Ann and Robert H. Lurie Children's Hospital of Chicago. "My colleagues and I have deployed tools inside electronic health record systems before, and we plan to deploy this tool in such a way that it can be shared across different health systems."

Future screening tools could also be built on the new criteria, allowing physicians to closely track and treat ill children, he says.

Source:
Journal reference:

Sanchez-Pinto, L. N., et al. (2024). Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. doi.org/10.1001/jama.2024.0196.

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