Phoenix Sepsis Score Calculator - Pediatric Sepsis Assessment Tool

Phoenix Sepsis Score Calculator

2024 International Consensus Criteria for Pediatric Sepsis and Septic Shock

Society of Critical Care Medicine (SCCM) - Evidence-Based Assessment

⚠ Important: For children <18 years. Not applicable to birth hospitalizations, neonates with postconceptional age <37 weeks. Requires suspected/confirmed infection.

1. Respiratory System (0-3 points)

PaO₂/FiO₂ Ratio (if available)

PaO₂ in mmHg, FiO₂ from 0.21 to 1.0

SpO₂/FiO₂ Ratio (if PaO₂ not available)

Only valid when SpO₂ ≤97%. SpO₂ as percentage, FiO₂ from 0.21 to 1.0

Invasive Mechanical Ventilation (IMV)

No Yes

Any Respiratory Support (O₂ therapy, high-flow, NIPPV, IMV)

No Yes

2. Cardiovascular System (0-6 points)

Number of Vasoactive Medications 0 - None 1 medication ≥2 medications

Dobutamine, dopamine, epinephrine, milrinone, norepinephrine, vasopressin

Lactate Level (mmol/L)

Reference range: 0.5-2.2 mmol/L. Can be arterial or venous.

Patient Age Select age group <1 month 1-11 months 1 to <2 years 2 to <5 years 5 to <12 years 12-17 years

Mean Arterial Pressure (MAP) in mmHg

Use measured MAP (invasive preferred) or calculate: DBP + (SBP - DBP)/3

3. Coagulation System (0-2 points)

Platelet Count (×10³/μL)

Reference range: 150-450 ×10³/μL

INR (International Normalized Ratio)

D-dimer (mg/L FEU)

Reference: <0.5 mg/L FEU

Fibrinogen (mg/dL)

Reference range: 180-410 mg/dL

4. Neurologic System (0-2 points)

Glasgow Coma Scale (GCS) Score

Eye (1-4) + Verbal (1-5) + Motor (1-6) = Total (3-15)

Pupillary Response

Normal/One fixed Both pupils fixed

Phoenix Sepsis Score

0

📋 How to Use This Tool

Step-by-Step Instructions:

1. Verify Patient Eligibility: Ensure patient is <18 years old, not a birth hospitalization, and postconceptional age ≥37 weeks
2. Confirm Infection: Patient must have suspected or confirmed infection (antimicrobial therapy initiated and microbiological testing ordered within 24 hours)
3. Enter Available Data: Fill in the fields for which you have data. Missing values automatically score as 0 points
4. Respiratory Section: Enter either PaO₂/FiO₂ OR SpO₂/FiO₂ (not both). SpO₂/FiO₂ only valid when SpO₂ ≤97%
5. Cardiovascular Section: Select age group first, then enter MAP and other cardiovascular parameters
6. Calculate: Click "Calculate Score" to see results and interpretation

Pros:

• ✓ Evidence-based - derived from >3 million pediatric encounters across 10 sites in 5 countries
• ✓ Better sensitivity and positive predictive value compared to SIRS-based criteria
• ✓ Validated in both high-resource and low-resource settings
• ✓ Focuses on life-threatening organ dysfunction rather than inflammatory response
• ✓ Can be calculated even with missing laboratory values
• ✓ Removes redundant term "severe sepsis"
• ✓ Applicable across emergency department and ICU settings

Cons & Limitations:

• ✗ Requires multiple laboratory values and measurements for optimal accuracy
• ✗ Not applicable to neonates <37 weeks postconceptional age
• ✗ May not be cost-effective to obtain all parameters in every suspected case
• ✗ Not designed for early screening before organ dysfunction is overt
• ✗ Neurologic scoring validated in sedated patients but interpretation may be challenging
• ✗ Lower MAP cutoff values than some traditional pediatric standards
• ✗ Requires clinical judgment - score alone should not replace comprehensive assessment
• ✗ Still undergoing prospective validation in various settings

Important Notes:

• This tool should complement, not replace, clinical judgment
• Use with surviving sepsis campaign guidelines for management
• Consider institutional protocols for sepsis screening and treatment
• Missing data is acceptable and maps to 0 points - consistent with real-world practice

📚 About the Phoenix Sepsis Score

Overview:

The Phoenix Sepsis Score represents the 2024 international consensus criteria for pediatric sepsis and septic shock, developed by the Society of Critical Care Medicine (SCCM) Pediatric Sepsis Definition Task Force. It supersedes the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria.

Development Process:

• Based on data from >3 million electronic health record encounters from 10 hospital sites across 4 continents
• International survey of 1,407 pediatric clinicians
• Systematic review and meta-analysis
• Modified Delphi consensus approach involving the international task force
• Published in JAMA, January 2024

Scoring System:

The Phoenix Score evaluates 4 organ systems:

• Respiratory (0-3 points): PaO₂/FiO₂ or SpO₂/FiO₂ ratio, invasive mechanical ventilation, any respiratory support
• Cardiovascular (0-6 points): Vasoactive medications (1-3 points), lactate level (1-2 points), age-adjusted MAP (1-2 points)
• Coagulation (0-2 points): Platelets, INR, D-dimer, fibrinogen
• Neurologic (0-2 points): Glasgow Coma Scale and pupillary response

Diagnostic Criteria:

• Sepsis: Phoenix Score ≥2 points in the context of suspected/confirmed infection
• Septic Shock: Sepsis with ≥1 cardiovascular point (severe hypotension for age, lactate >5 mmol/L, or need for vasoactive medication)

Clinical Outcomes:

• Children with Phoenix Score ≥2 had in-hospital mortality of 7.1% (high-resource) and 28.5% (low-resource settings)
• This represents >8 times the mortality of children with suspected infection not meeting criteria
• Children with septic shock had mortality rates of 10.8% (high-resource) and 33.5% (low-resource settings)

Key Advantages Over Previous Criteria:

• Eliminates SIRS criteria (poor predictive value, too sensitive)
• Removes redundant term "severe sepsis"
• Data-driven rather than expert opinion-based
• Validated across diverse resource settings
• Focuses on life-threatening organ dysfunction
• Allows for missing data without compromising utility

Exclusions:

• Birth hospitalizations
• Neonates with postconceptional age <37 weeks
• Children ≥18 years (use adult Sepsis-3 criteria)

References:

• Schlapbach LJ, Watson RS, Sorce LR, et al. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024;331(8):665-674.
• Sanchez-Pinto LN, Bennett TD, DeWitt PE, et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024;331(8):675-686.

Clinical Application:

The Phoenix Score should be used as part of comprehensive clinical assessment. It is not intended for early screening before organ dysfunction becomes apparent. Institutions should develop data-driven screening tools to identify at-risk children early, then apply Phoenix criteria to diagnose sepsis when organ dysfunction is present.

Future Directions:

• Ongoing prospective validation studies
• Integration into electronic health record systems
• Development of institutional screening protocols
• Assessment of impact on clinical outcomes

Disclaimer: This calculator is for educational and clinical reference purposes. Always use clinical judgment and institutional protocols. Not a substitute for comprehensive patient assessment.

Based on 2024 SCCM International Consensus Criteria | For Healthcare Professionals