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Systematic Screening for Sepsis/Septic Shock

Table titled "Clinical Criteria Suggestive of Sepsis or Septic Shock." Sepsis or septic shock may be suggested by a temperature abnormality, including fever greater than 38.3 degrees Celsius in children older than 3 months, fever greater than 38 degrees Celsius in infants younger than 3 months, hypothermia less than 36 degrees Celsius, or a temperature of 36 degrees Celsius with concern for infection. In addition to a temperature abnormality, one or more of the following may be present: mental status abnormalities such as anxiety, agitation, irritability, drowsiness, confusion, lethargy, or decreased alertness; perfusion abnormalities including prolonged capillary refill, diminished pulses, mottling, warm flushed extremities, bounding pulses, or low urine output; hypotension; or tachypnea. Additional factors associated with high risk for sepsis and organ dysfunction include metabolic acidosis, elevated lactate, thrombocytopenia, coagulopathy, elevated creatinine, age younger than 60 days, central line presence, malignancy, immunodeficiency, asplenia, sickle cell disease, immunosuppressive

Two tables showing proposed age-based vital sign thresholds used to identify abnormal vital signs in patients with suspected sepsis. The first table, titled "Emergency Department: Proposed Reference Values to Identify Age-Based Vital Sign Abnormalities," lists thresholds for tachycardia, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and tachypnea across five age groups: 0 to 2 months, 3 to 11 months, 12 to 47 months, 48 months to 11 years, and 12 years or older. Abnormal values include elevated heart rate, low blood pressure, low MAP, and increased respiratory rate, with thresholds varying by age. The second table, titled "Inpatient: Proposed Reference Values to Identify Age-Based Vital Sign Abnormalities," presents similar thresholds for six age groups: 0 to 1 month, 2 to 11 months, 1 to 2 years, 3 to 6 years, 7 to 13 years, and 14 years or older. A note beneath both tables states that heart rate can be affected by pain, anxiety, medications, and hydration status.

Phoenix Criteria for Sepsis and Septic Shock in Children
  • The Phoenix Sepsis Score is a research-based tool to assist in the evaluation for sepsis and septic shock in children
  • It calculates a result based on the levels of dysfunction for four organ systems (respiratory, cardiovascular, coagulation, and neurological). The score is used to estimate a patient's risk and outcomes
  • Since the Phoenix Sepsis Score relies on evidence of established organ dysfunction, it is primarily a diagnostic/classification tool rather than an early recognition or screening tool
References
Children's Hospital of Philadelphia. Signs and symptoms concerning for sepsis and septic shock. Accessed July 31, 2026. https://www.chop.edu/clinical-pathway/sepsis-emergency-department-inpatient-picu-clinical-pathway
Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8. doi:10.1097/01.PCC.0000149131.72248.E6
Gupta S, Sankar J. Advances in shock management and fluid resuscitation in children. Indian J Pediatr. 2023;90(3):280-288. doi:10.1007/s12098-022-04434-3
Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ; on behalf of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S337-S357. doi:10.1161/CIR.0000000000000918
Rutman L, Richardson T, Auletta J, et al; Improving Pediatric Sepsis Outcomes Collaborative Investigators. Association between Child Opportunity Index and paediatirc sepsis recognition and treatment in a large quality improvement collaborative: a retrospective cohort study. BMJ Qual Saf. Published online June 3, 2025. doi:10.1136/bmjqs-2024-017844
Schlapbach LJ, Watson RS, Sorce LR, et al; Society of Critical Care Medicine Pediatric Sepsis Definition Task Force. International consensus criteria for pediatric sepsis and septic shock. JAMA. 2024;331(8):665-674. doi:10.1001/jama.2024.0179
Weiss SL, Fitzgerald JC. Pediatric sepsis diagnosis, management, and sub-phenotypes. Pediatrics. 2024:153(1):e2023062967. doi:10.1542/peds.2023-062967
Weiss SL, Peters MJ, Oczkowski SJW, et al. Surviving Sepsis Campaign international guidelines for the management of sepsis and septic shock in children 2026. Pediatr Crit Care Med. 2026;27(4):379-434. doi:10.1097/PCC.0000000000003927

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

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