By IDSE News Staff
More accurate measures are needed to help diagnose children with sepsis, according to a new study. Research lead by Murdoch Children’s Research Institute (MCRI) found less than 5% of children admitted to the hospital with suspected sepsis met the Phoenix Sepsis Score, which could result in missed diagnoses (Lancet Reg Health West Pac 2025 Jul 21. doi:10.1016/j.lanwpc.2025.101608).
Sepsis is often difficult to diagnose due to its nonspecific symptoms, which can mimic other common illnesses. The condition is caused by the body’s extreme response to an infection where the immune system attacks healthy tissue in the body. Sepsis can lead to serious lung, kidney, liver and heart damage. Every year, about 25 million children are diagnosed with sepsis, resulting in 3 million deaths. WHO has identified pediatric sepsis as a global health priority.
“Severe infection and sepsis are major causes of childhood death,” said MCRI associate professor Elliot Long, PhD. Sepsis must be identified quickly and treatment started early to prevent life-threatening consequences. But there is limited research into how common sepsis is among children and what symptoms can be used by parents or clinicians to detect sepsis earlier.
“Country-specific sepsis data on incidence and severity has been infrequently and inconsistently reported due to a lack of clear diagnosis guidelines. As a result, the burden of sepsis on healthcare systems is largely unknown,” Dr. Long said.
To address this, the Society of Critical Care Medicine recently created and validated the Phoenix Sepsis Score. However, the score is a tool to predict life-threatening infection. “Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria,” the authors of the score wrote. “Mortality was higher in children who had organ dysfunction in at least 1 of 4-respiratory, cardiovascular, coagulation, and/or neurological-organ systems that was not the primary site of infection,“ they said (JAMA 2024;331[8]:665-674).
Dr. Long noted this is the first study to test and validate the new international sepsis criteria in emergency departments in Australia and New Zealand. “The findings will be critical to improving sepsis care,” he said. By detailing the incidence, severity and outcomes of childhood sepsis, we can identify gaps in healthcare and improve outcomes.”
The study involved 11 hospitals across Australia and New Zealand in the Peadiatric Research in Emergency Departments International Collaborative network, a collaboration of emergency departments, pediatric ICUs and inpatient wards.
Of the 6,232 children younger than 18 years of age with suspected sepsis, 306 fulfilled the Phoenix sepsis criteria. Most of the children were boys younger than 5 years of age who had underlying health conditions. Only 1% of children with a fever had sepsis.
The Phoenix Sepsis Score failed to detect cases early and underestimated the overall burden of disease, according to Dr. Long. “The Phoenix criteria didn’t pick up 95% of children hospitalized with sepsis,” he said. This high rate of missed cases is troubling for clinicians, researchers, policymakers and families because it does not tell the whole story.”
The study found 80% of children who fulfilled the Phoenix criteria were admitted to ICUs, almost all required medical interventions such as breathing support and their time in hospital was almost tripled.
“By failing to identify these children much earlier, before being admitted to intensive care, causes delays to treatment and impacts their recovery,” Dr. Long said.
Of note, more than half of the children who died did not fulfill the Phoenix criteria. Overall, 87 patients died within 90 days, but just 42 of those met the criteria. MCRI professor Franz Babl, MD, said the findings would help boost awareness of sepsis symptoms, ensure higher survival rates and improve quality of life.
“We haven’t substantially changed how we manage childhood sepsis in the past 20 years,” he 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.”
