Sepsis Definitions

Recommendations aimed at redefining the definitions of sepsis and septic shock and enhancing their diagnoses

International Consensus Criteria for Pediatric Sepsis and Septic Shock

January 22, 2024

The SCCM Pediatric Sepsis Definition Task Force developed new criteria for defining sepsis and septic shock in children based on evidence from an international survey, a 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. This new scoring matrix is known as the Phoenix Sepsis Score.

Based on survey data, most pediatric clinicians used the term “sepsis” to refer to infection with life-threatening organ dysfunction. This differs from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties. 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 neurologic systems.

Read the New Criteria
Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock

The SCCM Pediatric Sepsis Definitions Task Force included representatives from the following organizations who served as members of the task force:

American College of Emergency Physicians (Paul Ishimine, MD, FACEP, FAAP)
Associação de Medicina Intensiva Brasileira (Claudio Flauzino de Oliveira, MD, PhD)
European Society of Paediatric and Neonatal Intensive Care (Luregn Schlapbach, MD, PhD)
Infectious Diseases Society of America (Kathleen Chiotos, MD)
Pediatric Infectious Diseases Society (Kathleen Chiotos, MD)
World Federation of Pediatric Intensive and Critical Care Societies (Andrew C. Argent, MD, MBBCh, MMed)

The following organizations have endorsed the article:

American Association of Critical-Care Nurses
American College of Emergency Physicians
Asia Pacific Association of Critical Care Medicine
European Society of Paediatric and Neonatal Intensive Care
Global Sepsis Alliance
Indian Academy of Pediatrics - Intensive Care Chapter
Infectious Diseases Society of America
South African Paediatric Association
Swiss Society of Paediatrics
World Federation of Pediatric Intensive and Critical Care Societies

New Framework for Operationalizing Appropriate Sepsis Definitions in Children

April 25, 2023

A recent article published in Pediatric Critical Care Medicine outlines a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the operationalization of sepsis definitions in children globally. These criteria include:

Biological factors
Epidemiology
Differences in the pathways to care
Pretest probabilities of sepsis at different levels of care
Resources available for the provision of care

Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce
Read the Full Article

Recommendations Aim to Redefine Definitions and Enhance Diagnosis of Sepsis, Septic Shock

February 23, 2016

A task force of leading sepsis experts put forth important recommendations for physicians. The group’s recommendations not only advance definitions of sepsis and septic shock, but also offer clinical guidance to help physicians more quickly identify patients with or at risk of developing sepsis.

The recommendations were published in the February 2016 issue of JAMA and were highlighted for clinicians and media at the Society of Critical Care Medicine’s (SCCM) 45th Critical Care Congress in Orlando, Florida.

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
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The task force of 19 leaders in the field of sepsis was convened by SCCM and the European Society of Intensive Care Medicine (ESICM). The group’s recommendations have been endorsed by more than 30 medical societies from six continents, spanning disciplines from critical care and emergency medicine to infectious disease and family practice.

Current attention to sepsis is warranted. It is the leading cause of death from infection and its reported incidence is on the rise. In the United States, sepsis accounted for more than $20 billion in hospital costs in 2011. The 2016 recommendations define sepsis as life-threatening organ dysfunction due to a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities substantially increase mortality.

The 2016 definitions of sepsis and septic shock—the first revisions since 2001—reflect considerable advances made in the pathophysiology, epidemiology, and management of sepsis. The descriptions offer more specificity and are aimed at achieving greater clarity and consistency in the diagnosis, treatment, and reporting of sepsis. “This is an incredibly exciting time in the field of sepsis,” said Craig M. Coopersmith, MD, MCCM, a task force member and past president of SCCM. “Driven by a combination of data analysis on well over one million patients as well as expert consensus, these new definitions provide a real step forward.”

Absent from the 2016 definitions is the term “severe sepsis”—a significant change from previous definitions. The task force deemed this term redundant because sepsis has a mortality rate of at least 10%, meaning that it is already severe. “We want to underscore that sepsis itself is potentially life-threatening,” Dr. Coopersmith said. “Mortality rates from sepsis are higher than myocardial infarction, stroke, or trauma. Sepsis needs to be viewed with the same urgency as these other life-threatening conditions because we know that early treatment can decrease mortality.”

The task force’s 2016 sepsis definitions also draw attention to another important clinical consideration—organ dysfunction, which is the threshold that elevates uncomplicated infection to sepsis. The suggested method for assessing organ dysfunction is the Sequential (Sepsis-Related) Organ Failure Assessment (SOFA). “Physicians should be looking for organ dysfunction every time they suspect infection. Conversely, they need to be looking for infection whenever a patient presents with organ dysfunction,” Dr. Coopersmith said.

To facilitate sepsis diagnosis, the task force identified clinical criteria that physicians can use in their offices, emergency departments, and hospital wards to quickly evaluate patients for sepsis. The quick SOFA (qSOFA) consists of these three simple tests that clinicians can conduct at the bedside to identify patients at risk for sepsis:

Alteration in mental status
Decrease in systolic blood pressure to less than 100 mm Hg
Respiratory rate greater than 22 breaths/min

Data indicate that patients with two or more of these findings are at significantly greater risk of a prolonged (≥ 3 days) ICU stay or dying in the hospital. For these patients, the task force recommends that clinicians investigate further for organ dysfunction, initiate or escalate therapy as appropriate, and consider referral to critical care or increase monitoring frequency. “This is a new concept that gives physicians an easy-to-use tool to screen for sepsis,” Dr. Coopersmith said. “It can be done quickly and without a blood test.”

If a patient has at least two positive components of the qSOFA, the patient should be examined for organ failure. Septic shock differs from sepsis in that the complications are more severe and the risk of patient death is greater. The task force identified two new clinical criteria that clinicians should use in diagnosing patients with septic shock:

Persisting hypotension requiring vasopressors to maintain mean arterial pressure at or above 65 mm Hg
Blood lactate level greater than 2 mmol/L despite adequate volume resuscitation

Data indicate that mortality rates for patients with these two findings exceed 40%, or four times greater than for patients with sepsis.

The 2016 recommendations represent an important step forward but certainly not the last step in the evolving study of sepsis. The task force recommended that its report be designated “Sepsis-3,” recognizing the two earlier iterations to define sepsis (1991 and 2001) and signaling the need for future study. “Our work in sepsis remains very much a work in progress,” Dr. Coopersmith said. “We’ve come a long way, but there is still much more to do to ensure that patients are safe and healthcare professionals are informed.”