Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock

作者：L. Nelson Sanchez‐Pinto, Tellen D. Bennett, Peter E. DeWitt, Seth Russell, Margaret Rebull, Blake Martin, Samuel Akech, David J. Albers, Elizabeth R. Alpern, Fran Balamuth, Melania M. Bembea, Mohammod Jobayer Chisti, Idris Evans, Christopher M. Horvat, Juan Camilo Jaramillo-Bustamante, Niranjan Kissoon, Kusum Menon, Halden F. Scott, Scott L. Weiss, Matthew O. Wiens, Jerry J. Zimmerman, Andrew C. Argent, Lauren R. Sorce, Luregn J. Schlapbach, R. Scott Watson, Society of Critical Care Medicine Pediatric Sepsis Definition Task Force, Paolo Biban, Enitan D. Carrol, Kathleen Chiotos, Cláudio Flauzino de Oliveira, Mark W. Hall, David Inwald, Paul Ishimine, Michael Levin, Rakesh Lodha, Simon Nadel, Satoshi Nakagawa, Mark Peters, Adrienne G. Randolph, Suchitra Ranjit, Daniela Carla de Souza, Pierre Tissières, James L. Wynn · 发表于：JAMA · 年份：2024 · DOI：10.1001/jama.2024.0196 · 被引用次数：229 · 研究领域：Sepsis Diagnosis and Treatment、Neonatal and Maternal Infections、Injury Epidemiology and Prevention

Importance: The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force sought to develop and validate new clinical criteria for pediatric sepsis and septic shock using measures of organ dysfunction through a data-driven approach. Objective: To derive and validate novel criteria for pediatric sepsis and septic shock across differently resourced settings. Design, Setting, and Participants: Multicenter, international, retrospective cohort study in 10 health systems in the US, Colombia, Bangladesh, China, and Kenya, 3 of which were used as external validation sites. Data were collected from emergency and inpatient encounters for children (aged <18 years) from 2010 to 2019: 3 049 699 in the development (including derivation and internal validation) set and 581 317 in the external validation set. Exposure: Stacked regression models to predict mortality in children with suspected infection were derived and validated using the best-performing organ dysfunction subscores from 8 existing scores. The final model was then translated into an integer-based score used to establish binary criteria for sepsis and septic shock. Main Outcomes and Measures: The primary outcome for all analyses was in-hospital mortality. Model- and integer-based score performance measures included the area under the precision recall curve (AUPRC; primary) and area under the receiver operating characteristic curve (AUROC; secondary). For binary criteria, primary performance measures were positive...