Is There a Better Way to Catch Sepsis Sooner? A New Study Puts Different Tools to The Test

Editor’s Note: Dr. Elif Ozdogan (she/her) is a resident physician in Pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is interested in quality improvement and computational research and hopes to pursue further training in transplant medicine. 

Fever is perhaps the most common reason for children to interact with healthcare when sick. In fact, it accounts for up to one-third of pediatric emergency department (ED) visits. The natural response of the body to infections is mounting inflammation (and the first sign of this is often fever), which helps our immune system get rid of the responsible agent. Sepsis and septic shock can be a result of this inflammatory reaction. They occur when the inflammatory response is out of control and can result in dysfunction and damage of vital organs.

When we treat sepsis, time is of the essence: early detection makes a big difference. This is even described as the “golden hour,” as starting antibiotics within the first hour of presentation dramatically improves outcomes.

However, identifying and diagnosing sepsis may not be straightforward, especially in a busy ED. Recently, a set of clinical and laboratory criteria, called the Phoenix criteria, were developed to standardize the diagnosis of sepsis and septic shock. These criteria help identify children who are already showing signs of organ dysfunction, highlighting the importance of ideally simple and reliable tools that can catch sepsis as early as possible. 

In the article entitled “Comparing Screening Tools for Predicting Phoenix Criteria Sepsis and Septic Shock Among Children” being early released this week in Pediatrics, Nathan Georgette MD, and colleagues from Boston Children’s Hospital compared the performance of three screening tools in predicting patients who would later develop organ dysfunction and meet the Phoenix criteria (10.1542/peds.2025-071155). These tools differ from each other in multiple ways but commonly make use of direct bedside clinical assessments such as abnormal vital signs, signs of poor circulation, or changes in alertness.

The researchers analyzed data from 47,000 pediatric patients who visited a single ED between 2012 and 2021 for suspected infection to analyze outcomes and performance of the screening tools. Eventually, 1.3% of the patients developed sepsis, and 0.5% developed septic shock.

The quick Pediatric Septic Shock Screening Score (qPS4), developed recently by the authors of this article, had the highest sensitivity of all three tools, meaning that it was able to catch more patients with early sepsis. However, the Liverpool quick Sequential Organ Failure Assessment (LqSOFA) and the Children’s Hospital of Philadelphia (CHOP) Sepsis Screen had higher specificity (fewer number of false positives) and higher positive predictive value (more positive tests correctly identifying patients with sepsis). With screening tools sensitivity is often prioritized above specificity to catch as many patients as possible. This table summarizes each tool and its performance in this study. 

Comparison of Pediatric Sepsis Screening Tools

As pediatric sepsis remains a time-sensitive and high-stakes condition, the tools we use to detect it must evolve alongside our understanding of the disease. This study highlights the potential of qPS4 as a more sensitive option for early recognition and therefore, early intervention. Notably, these tools incorporated similar clinical parameters—emphasizing the importance of a good physical exam. Future next steps should include multi-center and diverse patient populations, and a prospective study to see how implementation of such tools in clinical practice affects patient outcomes. 

This study comes highly recommended for those interested in insights about early identification of sepsis and the role of widely available and simple bedside assessments in making this possible.