Carter Michael J, Hageman Joshua, Feinstein Yael, Herberg Jethro, Kaforou Myrsini, Peters Mark J, Nadel Simon, Edmonds Naomi, Pathan Nazima, Levin Michael, Ramnarayan Padmanabhan
Paediatric Intensive Care Unit, John Radcliffe Hospital, Oxford, United Kingdom.
Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.
Pediatr Crit Care Med. 2025 Feb 1;26(2):e186-e196. doi: 10.1097/PCC.0000000000003682. Epub 2025 Jan 2.
To assess characteristics and outcomes of children with suspected or confirmed infection requiring emergency transport and PICU admission and to explore the association between the 2024 Phoenix Sepsis Score (PSS) criteria and mortality.
Retrospective analysis of curated data from a 2014-2016 multicenter cohort study.
PICU admission following emergency transport in South East England, United Kingdom, from April 2014 to December 2016.
Children 0-16 years old ( n = 663) of whom 444 (67%) had suspected or confirmed infection.
None.
The PSS was calculated as a sum of four individual organ subscores (respiratory, cardiovascular, neurological, and coagulation) using the worst values during transport (i.e., from referral until the time of PICU admission). A score cutoff of greater than or equal to 2 points was used to define sepsis; and septic shock was defined as sepsis plus 1 or more cardiovascular subscore points. Sepsis occurred in 260 of 444 children (58.6%) with suspected or confirmed infection, with septic shock occurring in 177 of 260 (68.1%) of those with sepsis. A PSS score greater than or equal to 2 points occurred in 37 of 67 bronchiolitis cases, 19 of 35 meningoencephalitis cases, 30 of 47 pneumonia/empyema cases, 38 of 46 septic/toxic shock cases, nine of 15 severe sepsis cases, and 58 of 118 definite viral infections. Overall, 14 of 444 children died (3.2%). There were 12 deaths in the 260 children with PSS greater than or equal to 2, and two deaths in the 184 children with PSS less than 2 (4.6% vs. 1.1%; absolute difference, 3.5%; 95% CI, 0.1-6.9%; p = 0.04).
In 2014-2016, over half of the critically ill children undergoing emergency transport to PICU with presumed or confirmed infection, and meeting retrospectively applied PSS criteria for sepsis, had a range of clinical diagnoses including bronchiolitis, meningoencephalitis, and pneumonia/empyema. Furthermore, the PSS criteria for categorization of sepsis and septic shock were associated with outcome and may be of value in future risk-stratification in clinical trials.
评估需要紧急转运并入住儿科重症监护病房（PICU）的疑似或确诊感染儿童的特征及预后，并探讨2024年凤凰脓毒症评分（PSS）标准与死亡率之间的关联。
对2014 - 2016年多中心队列研究的整理数据进行回顾性分析。
2014年4月至2016年12月在英国英格兰东南部进行紧急转运后入住PICU。
0 - 16岁儿童（n = 663），其中444名（67%）有疑似或确诊感染。
无。
PSS通过将四个单独的器官子评分（呼吸、心血管、神经和凝血）相加得出，使用转运期间（即从转诊到入住PICU时）的最差值。PSS评分大于或等于2分被用于定义脓毒症；脓毒性休克定义为脓毒症加上1个或更多心血管子评分点。444名疑似或确诊感染儿童中有260名（58.6%）发生脓毒症，其中260名脓毒症患者中有177名（68.1%）发生脓毒性休克。67例毛细支气管炎病例中有37例PSS评分大于或等于2分，35例脑膜脑炎病例中有19例，47例肺炎/脓胸病例中有30例，46例脓毒症/中毒性休克病例中有38例，15例严重脓毒症病例中有9例，118例确诊病毒感染病例中有58例。总体而言，444名儿童中有14名死亡（3.2%）。PSS大于或等于2分的260名儿童中有12例死亡，PSS小于2分的184名儿童中有2例死亡（4.6%对1.1%；绝对差值3.5%；95%CI，0.1 - 6.9%；p = 0.04）。
在2014 - 2016年，超过一半的因疑似或确诊感染而接受紧急转运至PICU且符合回顾性应用的脓毒症PSS标准的重症儿童，有一系列临床诊断，包括毛细支气管炎、脑膜脑炎和肺炎/脓胸。此外，脓毒症和脓毒性休克分类的PSS标准与预后相关，可能对未来临床试验中的风险分层有价值。
