By Cynthia Tang, RHIA, CCS, Pinson & Tang LLC and Ara Balkian, MD, MBA, Founder & CEO, Pediatric Resource Group

Since 2005, the diagnosis of pediatric sepsis has been based on the pediatric sepsis definitions and criteria of the 2005 “International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics” published in Pediatric Critical Care Medicine. These were based on pediatric SIRS criteria.

“International Consensus Criteria for Pediatric Sepsis and Septic Shock” was published in March 2024 in JAMA with criteria now based on the Phoenix Sepsis Score. There are many similarities to the 2016 Sepsis-3 criteria for the adult population. For Sepsis-3, sepsis is defined as a suspected/confirmed infection with life-threatening organ dysfunction based on six different organ systems as determined by the SOFA score of at least 2 points.

Here are the Phoenix Sepsis Score definitions for use with pediatric patients:

  • Sepsis in children is now identified by a Phoenix Sepsis Score of at least 2 points in children with suspected/confirmed infection, which indicates potentially life-threatening dysfunction of four organ systems: respiratory, cardiovascular, coagulation, and/or neurological.
  • Septic shock is defined as meeting sepsis criteria with any cardiovascular dysfunction indicated by at least 1 or more points from the cardiovascular organ system.

The new pediatric sepsis definition (like Sepsis-3) requires acute organ dysfunction as part of the definition of sepsis. Therefore, all cases which meet the pediatric sepsis definition would meet the definition of severe sepsis.

Phoenix Sepsis Score

IMV = invasive mechanical ventilation

For example, a 6-year-old child with a PaO2/FIO2 (P/F ratio) < 400 on oxygen and on vasoactive medications for hypotension would meet the criteria for septic shock.

Age Restrictions: Age measurements are not adjusted for prematurity. The Phoenix criteria was developed on non-birth hospitalizations (implication is age > 0), children when gestational age > 37 weeks; and those aged ≤ 216 months (18 years).

What can we do?

The new International Consensus Criteria for pediatric sepsis states that the former criteria based on systemic inflammatory response syndrome (SIRS) should no longer be used to diagnose sepsis in children. It is important that hospitals educate their medical staff on this new definition.

CDI and coding professionals should begin using the new pediatric sepsis definitions and Phoenix Sepsis Score for clinical validation. Because these new criteria may be more stringent than the previous 2005 criteria based on SIRS, it is anticipated that payer auditors who are paying attention may start using these new definitions and criteria for the clinical validation of pediatric sepsis. Be watchful and push back should payers try to apply these criteria retroactively to discharges prior to March 2024. But be prepared: successful appeal is unlikely unless Phoenix Sepsis Score criteria are met.

CDI Pocket Guide® Unbound (Online) Edition now includes Pediatric and Neonatal content! In partnership with Pediatric Resource Group (PRG), Pinson & Tang has added a comprehensive pediatric and neonatal module with over 40 key reference topics tailored to meet the unique needs of CDI specialists, coding professionals, and providers in pediatric healthcare settings.  Find the complete Pediatric Sepsis definitions and criteria in the CDI Pocket Guide® Unbound Edition. 

CDI Pocket Guide®
Offered as an always up-to-date online version or the classic spiral-bound format sized to literally “fit in your pocket.” Get the best of both worlds — purchase hard copy and online versions together and save! More info

Pediatric CDI Educational Series
The most comprehensive collection of pediatric CDI educational videos is now offered by Libman Education!
More info

 

About the authors:
Cynthia Tang, RHIA, CCS
Cynthia Tang brings over 30 years of experience in health information management, coding and clinical documentation, and clinical resource management. For the past twenty years she has traveled to hospitals throughout the country to assess their processes for managing health information and clinical documentation and to provide her much-sought after expertise in redesigning operations to promote better patient care and hospital financial health. Her focus is on workflow design and improving clinical documentation with a view to optimizing reimbursement, ensuring compliance, and improving quality and pay for performance measures.

Ara Balkian, MD, MBA
Ara Balkian is the founder and CEO of Pediatric Resource Group (PRG). He was the first hospitalist at Children’s Hospital Los Angeles (CHLA) and was the Associate Head of the Division of Hospital Medicine and the Associate Chair for the Department of Pediatrics until he took on his current role of Chief Medical Director of Inpatient Operations.

In that role, he has leadership over the Inpatient Access & Transfer Center, which is responsible for the handling of almost 18,000 admissions a year. He also leads the hospital’s utilization management (UM) program and chairs the UM committee. He is the medical director for inpatient care coordination and leads CHLA’s throughput management efforts. He helped develop and continues to lead the Clinical Documentation Improvement (CDI) program. He developed and leads the Physician Advisor program and the Denials Management program.

He has lectured nationally on topics related to hospital reimbursement, CDI, denials management, and pediatric physician advisor program development. He continues to see patients and teach trainees as a pediatric hospitalist and his research interests are focused on the efficient delivery of inpatient pediatric care.

The driving force for starting PRG is his desire to leverage his experience and team of experts to positively affect pediatric organizations around the country with the ultimate goal of expanding and improving the care provided to children.