Diagnostic tool missing 95% of kids hospitalised with sepsis: Study

An estimated 50 infants and children die as a result of sepsis every year in Australia, with the condition accounting for around 500 paediatric intensive care admissions annually.
 
But cases can be difficult to diagnose, particularly in the early stages, with symptoms often non-specific and mimicking those of common illnesses, such as a cold or influenza.
 
To help overcome this and assist with diagnosis, the Society of Critical Care Medicine Pediatric Sepsis Definition Task Force created the Phoenix Sepsis Score in January 2024 as part of an update to the paediatric sepsis criteria.
 
However, new research says the clinical tool fails to detect the majority of those requiring hospital care.
 
The MCRI’s study is the first to test and validate the Phoenix Sepsis Score in emergency departments across Australia and New Zealand.
 
The study, led by the Murdoch Children’s Research Institute (MCRI), involved 6232 children aged under 18 years with suspected sepsis, the majority of whom were boys aged under five with underlying health conditions.
 
It found that 306 fulfilled the Phoenix sepsis criteria, and that less than 5% of children admitted to hospital with suspected sepsis met this criteria.
 
‘The Phoenix criteria identify a cohort with substantially worse clinical outcomes, but do not identify many patients who require ICU-level care or who die within 90 days, underscoring the importance of alternative methods for case ascertainment,’ the study concluded.
 
Associate Professor Elliot Long, who is a clinician-scientist and sepsis research team leader at MCRI and an emergency physician at The Royal Children’s Hospital, said the Phoenix score failed to detect cases early and underestimated the overall burden of disease.
 
‘The Phoenix criteria didn’t pick up 95% of children hospitalised with sepsis,’ Associate Professor Long said.
 
‘This high rate of missed cases is troubling for clinicians, researchers, policymakers and families because it does not tell the whole story.’
 
Of those children who fulfilled the Phoenix criteria for sepsis, 80% were admitted to intensive care, with almost all requiring medical interventions such as breathing support.
 
Associate Professor Long said failure to identify these children earlier, prior to being admitted to intensive care, caused delays in treatment and impacted their recovery.  
 
‘Severe infection and sepsis are major causes of childhood death,’ he said. ‘Sepsis must be identified quickly and treatment started urgently to prevent life threatening consequences.’
 
One of the most concerning findings, however, was that 87 of the children died within 90 days, but just 42 of those had met the Phoenix criteria.
 
Children account for more than half of sepsis cases globally, with more than 25 million children diagnosed with the condition each year, just over three million of whom die as a result. These numbers led the World Health Organization to identify paediatric sepsis as a global health priority in 2017.
 
Despite this, there is limited research into what symptoms can be used by parents or clinicians to detect the condition earlier.
 
Associate Professor Long said the findings ‘will be critical’ to improving sepsis care.
 
‘By detailing the incidence, severity, and outcomes of childhood sepsis we can identify gaps in healthcare and improve outcomes,’ he said.
 
Professor Franz Babl, who is the group leader of Emergency Research at the Murdoch Children’s Research Institute said the study’s findings will help to increase awareness of symptoms to ensure higher survival rates and improve quality of life.
 
‘We haven’t substantially changed how we manage childhood sepsis in the past 20 years,’ Professor Babl said.
 
‘There are enormous knowledge gaps in how to best treat sepsis. Some treatments can even cause additional damage to patients, rather than helping them. Patients urgently need safe and effective alternatives.’
 
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