The Phoenix Criteria and Other Severity Scores in Identifying Pediatric Sepsis
Authors' conclusion
In this cohort study of hospitalized patients with presumed infection in Hong Kong, the Phoenix criteria effectively identified patients at high risk of death across the full spectrum of inpatient care and offered the most favorable balance of mortality discrimination and data availability among the severity scores evaluated.
Study context
- Population
- Children 28 days to <18 years with presumed infection hospitalised at 36 public hospitals in Hong Kong, 2009–2024presumed infection
- Participants
- 140,633 children
- Exposure
- Phoenix-8 vs Phoenix-4, pediatric Sequential Organ Failure Assessment (pSOFA) and PELOD-2 for hospital mortality prediction
- Outcome
- Performance (AUPRC, AUROC, sensitivity, specificity) for all-cause hospital mortality
Methodological detailsmulticentre, population-based electronic health record (EHR)
- Multicentre
- Population-based EHR
Main finding
As reported in the abstract
All-cause hospital mortality discrimination
| Group | Area under the precision recall curve (AUPRC) | AUROC |
|---|---|---|
| Phoenix-8 | 0.27 (95% CI, 0.23-0.32) | 0.91 (95% CI, 0.89-0.93) |
| Phoenix-4 | 0.23 (95% CI, 0.19-0.27) | 0.90 (95% CI, 0.88-0.91) |
| pSOFA | 0.15 (95% CI, 0.12-0.19) | 0.80 (95% CI, 0.78-0.83) |
| PELOD-2 | 0.29 (95% CI, 0.24-0.33) | 0.89 (95% CI, 0.87-0.91) |
Area under the precision recall curve (AUPRC)
Phoenix-80.27 (95% CI, 0.23-0.32)
Phoenix-40.23 (95% CI, 0.19-0.27)
pSOFA0.15 (95% CI, 0.12-0.19)
PELOD-20.29 (95% CI, 0.24-0.33)
AUROC
Phoenix-80.91 (95% CI, 0.89-0.93)
Phoenix-40.90 (95% CI, 0.88-0.91)
pSOFA0.80 (95% CI, 0.78-0.83)
PELOD-20.89 (95% CI, 0.87-0.91)
Observational data: associations, not effects.
Further findings
Mean
| Outcome | Phoenix-8 | Phoenix-4 | pSOFA | PELOD-2 | P value |
|---|---|---|---|---|---|
| Hospital mortality by Phoenix-8 statusSepsis vs Uncomplicated infection | P < 0.001 | ||||
| Mean EHR data availability for score variables | 43.3% (95% CI 43.2%–43.4%) | 28.6% (95% CI 28.5%–28.7%) | 50.7% (95% CI 50.6%–50.7%) | 38.7% (95% CI 38.6%–38.7%) |
- Sepsis prevalence (Phoenix-8 ≥2): Sepsis 5.4% (95% CI 5.2%–5.5%)
- Sepsis prevalence (Phoenix-8 ≥2): Uncomplicated infection 94.6% (95% CI 94.5%–94.8%)
- Hospital mortality by Phoenix-8 status: Sepsis 4.5% (95% CI 4.0%–5.0%)
- Hospital mortality by Phoenix-8 status: Uncomplicated infection 0.1% (95% CI 0.1%–0.1%)
Original publication
The Phoenix Criteria and Other Severity Scores in Identifying Pediatric Sepsis. JAMA Netw Open. Published 1 June 2026. doi:10.
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