Prognostic Accuracy of the Phoenix Sepsis Criteria for Mortality in Children With Suspected Infection: A Systematic Review and Meta-Analysis.

Abstract

Objectives: We aimed to evaluate the pooled prognostic accuracy of the Phoenix Sepsis Criteria (PSC) for in-hospital mortality and compare its performance with the International Pediatric Sepsis Consensus Conference (IPSCC) criteria in children with suspected infection.

Data sources: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched.

Study selection: Eligible studies included prospective or retrospective studies evaluating the PSC among children younger than 18 years with suspected infection in hospital settings.

Data extraction: Two investigators independently screened, extracted study characteristics and accuracy data, and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Data synthesis: A total of 15 studies (16 cohorts; 2,601,038 encounters) were included. The PSC demonstrated pooled sensitivity of 0.77 (95% CI, 0.67-0.85), specificity of 0.73 (95% CI, 0.51-0.87), diagnostic odds ratio of 9.2 (95% CI, 5.1-16.8), and area under the curve (AUC) of 0.81 (95% CI, 0.75-0.84). In contrast, the IPSCC showed lower performance (AUC, 0.71; difference, 0.10 [95% CI, 0.04-0.19]). In subgroup analyses, PSC specificity was lower in the ICU compared with the emergency department (ED) cohorts (0.48 vs. 0.99).

Conclusions: The PSC demonstrates good prognostic accuracy for mortality and outperforms the IPSCC criteria. However, performance varies by setting, and the PSC is intended for prognostic risk stratification rather than frontline early sepsis screening. Further validation in the ED, ward, and lower-resource settings, as well as the development of context-specific clinical decision support tools, are warranted.