Sick or Not Sick works until it doesn’t.

The “gap kids” may need observation or further investigation.

SIRS is OUT — your clinical judgement is IN.

Use the Phoenix Sepsis Score to determine the diagnosis of sepsis and septic shock, decide level of care.

Sepsis diagnosis is operationalized as 2 points or more on the Phoenix Sepsis Score, and septic shock as sepsis with cardiovascular dysfunction (see the Table).
^aInstitutionally available procedures to identify deteriorating patients with infection should be followed for screening. There is a need for data-driven tools to screen children at risk of development of sepsis, which must be rigorously evaluated in different populations and contexts. The Phoenix Sepsis Score is not intended for early screening or recognition of possible sepsis and management before organ dysfunction is overt.
^bPlease refer to the Table for the Phoenix Sepsis Score.

Schlapbach LJ, Watson RS, Sorce LR, et al. International Consensus Criteria for Pediatric Sepsis and Septic Shock. *JAMA*. 2024;331(8):665-674. doi:10.1001/jama.2024.0179

Schlapbach LJ, Watson RS, Sorce LR, et al. International Consensus Criteria for Pediatric Sepsis and Septic Shock. *JAMA*. 2024;331(8):665-674. doi:10.1001/jama.2024.0179

Formula for Normal Mean Arterial Pressure in Children:

MAP = 1.5 x Age + 55

This is for a child in the 50th percentile for height and weight

Selected References

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

Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007;8(2):138-144. doi:10.1097/01.PCC.0000257039.32593.DC

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. doi:10.1001/jama.2024.0196

Schlapbach LJ, Watson RS, Sorce LR, et al. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024;331(8):665-674. doi:10.1001/jama.2024.0179

Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [published correction appears in JAMA. 2016 May 24-31;315(20):2237]. JAMA. 2016;315(8):762-774. doi:10.1001/jama.2016.0288