PDF(Pubmed)
Abstract：
Sepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children.
To update and evaluate criteria for sepsis and septic shock in children.
The Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria.
Based on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. 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. 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. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.
The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.
To update and evaluate criteria for sepsis and septic shock in children.
The Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria.
Based on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. 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. 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. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.
The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.
摘要：
■脓毒症是全球儿童死亡的主要原因。根据专家意见，2005年发布了当前儿科特定的脓毒症标准。2016年，关于脓毒症和脓毒症休克的第三次国际共识定义（Sepsis-3）将脓毒症定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍。但它排除了孩子。
■更新和评估儿童脓毒症和脓毒性休克的标准。
重症监护医学学会（SCCM）召集了一个由35名儿科重症监护专家组成的工作组，急诊医学,传染病,普通儿科,护理,公共卫生,和来自6大洲的新生儿科。利用国际调查的证据，系统回顾和荟萃分析，根据来自4大洲10个地点的300多万份电子健康记录，制定了新的器官功能障碍评分，采用改良的Delphi共识程序来制定标准.
■根据调查数据，大多数儿科临床医生使用脓毒症来指代感染危及生命的器官功能障碍，与先前使用全身炎症反应综合征（SIRS）标准的儿科脓毒症标准不同，它们的预测特性很差，包括多余的术语，严重的败血症.SCCM特别工作组建议，在疑似感染的儿童中，通过凤凰城败血症评分至少为2分，来识别儿童败血症。这表明可能危及生命的呼吸功能障碍，心血管,凝血,和/或神经系统。凤凰城脓毒症评分至少2分的儿童在资源较高的环境中住院死亡率为7.1％，在资源较低的环境中为28.5％。不符合这些标准的疑似感染儿童的8倍以上。在至少4个呼吸道器官功能障碍的儿童中，死亡率更高，心血管,凝血,和/或不是主要感染部位的神经系统。败血症性休克定义为患有心血管功能障碍的败血症儿童，凤凰城脓毒症评分中至少有1个心血管点表示，其中包括严重的低血压，血乳酸超过5mmol/L，或者需要血管活性药物。在较高和较低的资源环境中，感染性休克儿童的住院死亡率为10.8％和33.5％。分别。
■Phoenix脓毒症标准是由国际SCCM儿科脓毒症定义工作组使用大型国际数据库和调查得出和验证的，系统回顾和荟萃分析，和改进的德尔菲共识方法。Phoenix脓毒症评分至少为2，在18岁以下的感染儿童中发现了可能危及生命的器官功能障碍。它的使用有可能改善临床护理，流行病学评估，以及世界各地儿科脓毒症和脓毒性休克的研究。
■更新和评估儿童脓毒症和脓毒性休克的标准。
重症监护医学学会（SCCM）召集了一个由35名儿科重症监护专家组成的工作组，急诊医学,传染病,普通儿科,护理,公共卫生,和来自6大洲的新生儿科。利用国际调查的证据，系统回顾和荟萃分析，根据来自4大洲10个地点的300多万份电子健康记录，制定了新的器官功能障碍评分，采用改良的Delphi共识程序来制定标准.
■根据调查数据，大多数儿科临床医生使用脓毒症来指代感染危及生命的器官功能障碍，与先前使用全身炎症反应综合征（SIRS）标准的儿科脓毒症标准不同，它们的预测特性很差，包括多余的术语，严重的败血症.SCCM特别工作组建议，在疑似感染的儿童中，通过凤凰城败血症评分至少为2分，来识别儿童败血症。这表明可能危及生命的呼吸功能障碍，心血管,凝血,和/或神经系统。凤凰城脓毒症评分至少2分的儿童在资源较高的环境中住院死亡率为7.1％，在资源较低的环境中为28.5％。不符合这些标准的疑似感染儿童的8倍以上。在至少4个呼吸道器官功能障碍的儿童中，死亡率更高，心血管,凝血,和/或不是主要感染部位的神经系统。败血症性休克定义为患有心血管功能障碍的败血症儿童，凤凰城脓毒症评分中至少有1个心血管点表示，其中包括严重的低血压，血乳酸超过5mmol/L，或者需要血管活性药物。在较高和较低的资源环境中，感染性休克儿童的住院死亡率为10.8％和33.5％。分别。
■Phoenix脓毒症标准是由国际SCCM儿科脓毒症定义工作组使用大型国际数据库和调查得出和验证的，系统回顾和荟萃分析，和改进的德尔菲共识方法。Phoenix脓毒症评分至少为2，在18岁以下的感染儿童中发现了可能危及生命的器官功能障碍。它的使用有可能改善临床护理，流行病学评估，以及世界各地儿科脓毒症和脓毒性休克的研究。
