Since 2005, the diagnosis of pediatric sepsis has been based on the pediatric sepsis definitions and criteria of the 2005 International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics published in Pediatric Critical Care Medicine. These were based on pediatric SIRS criteria.

A new International Consensus Criteria for Pediatric Sepsis and Septic Shock was published in March 2024 in JAMA which is now based on the Phoenix Sepsis Score. There are many similarities to the 2016 Sepsis-3 criteria for the adult population. For Sepsis-3, sepsis is defined as a suspected/confirmed infection with life-threatening organ dysfunction based on six different organ systems as determined by the SOFA score of at least 2 points.

Sepsis in children is now identified by a Phoenix Sepsis Score of at least 2 points in children with suspected/confirmed infection, which indicates potentially life-threatening dysfunction of four organ systems: respiratory, cardiovascular, coagulation, and/or neurological. Septic shock is defined as meeting sepsis criteria with any cardiovascular dysfunction indicated by at least 1 or more points from the cardiovascular organ system.

The new pediatric sepsis definition (like Sepsis-3) requires acute organ dysfunction as part of the definition of sepsis.  Therefore, all cases which meet the pediatric sepsis definition would meet the definition of severe sepsis.

Phoenix Sepsis Scoring System:

For example, a 6-year-old child with a PaO2/FIO2 (P/F ratio) < 400 on oxygen and on vasoactive medications for hypotension would meet the criteria for septic shock.

Find the complete Pediatric Sepsis definitions and criteria in the CDI Pocket Guide® Unbound Edition.

What can we do?

The new International Consensus Criteria for pediatric sepsis states that the former criteria based on systemic inflammatory response syndrome (SIRS) should no longer be used to diagnose sepsis in children. It’s important that hospitals educate their medical staff on this new definition.

CDI and coding professionals should begin using the new pediatric sepsis definitions and Phoenix Sepsis Score for clinical validation. Payer auditors may start using these new definitions and criteria for the clinical validation of pediatric sepsis. Successful appeal is unlikely unless Phoenix Sepsis Score criteria are met. Payers should not apply these criteria retroactively to discharges prior to March 2024.

Pinson & Tang has recently partnered with Pediatric Resource Group (PRG) to provide comprehensive pediatric and neonatal content within the CDI Pocket Guide® Unbound Edition that includes over 40 pediatric key reference topics. This collaboration with PRG marks a significant mil