{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T02:38:16Z","timestamp":1794537496821,"version":"4.9.1"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Although the Phoenix sepsis criteria were developed from international cohorts, their performance in mortality prediction and feasibility for routine electronic health record (EHR) applications have been understudied outside of pediatric intensive care units and high-income settings outside of the US.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To validate the Phoenix criteria\u2019s mortality prediction performance against other severity scores, and to evaluate the feasibility of using routine EHR data for identifying pediatric sepsis across the full spectrum of hospital care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study analyzed pediatric hospitalizations between April 1, 2009, and March 31, 2024, at 36 publicly funded hospitals in Hong Kong, China. The cohort included children 28 days to younger than 18 years of age with presumed infection. Hong Kong\u2019s population-based EHR\u2014Clinical Data Analysis and Reporting System (CDARS)\u2014was the source of inpatient and outpatient clinical data, including demographic characteristics, medication records, and laboratory and microbiological results.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n The Phoenix-8 criteria were used primarily, defining sepsis as a score of 2 or higher and uncomplicated infection as a score lower than 2. Other severity scores\u2014Phoenix-4, pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Logistic Organ Dysfunction version 2 (PELOD-2)\u2014were also calculated.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Performance of Phoenix-8 criteria and comparator severity scores for all-cause hospital mortality was assessed by area under the precision recall curve (AUPRC), area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. Availability of EHR data within the CDARS was determined for score calculation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 140\u202f633 patients with presumed infection (median [IQR] age, 4.0 [1.0-8.0] years; 77\u202f665 males [55.2%]), 7547 (5.4%; 95% CI, 5.2%-5.5%) met the Phoenix-8 criteria for sepsis; 133\u202f086 patients (94.6%; 95% CI, 94.5%-94.8%) were classified as having uncomplicated infection. Patients who met the Phoenix-8 criteria had higher mortality (4.5% [95% CI, 4.0%-5.0%; n\u2009=\u2009337] vs 0.1% [95% CI, 0.1%-0.1%; n\u2009=\u2009114];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) than patients with uncomplicated infection. Phoenix-8 demonstrated an AUPRC of 0.27 (95% CI, 0.23-0.32) and an AUROC of 0.91 (95% CI, 0.89-0.93) for mortality, outperforming pSOFA (AUPRC: 0.15 [95% CI, 0.12-0.19]; AUROC: 0.80 [95% CI, 0.78-0.83]), but not Phoenix-4 (AUPRC: 0.23 [95% CI, 0.19-0.27]; AUROC: 0.90 [95% CI, 0.88-0.91]) or PELOD-2 (AUPRC: 0.29 [95% CI, 0.24-0.33]; AUROC: 0.89 [95% CI, 0.87-0.91]). Mean data availability for variables required in score calculation was 50.7% (95% CI, 50.6%-50.7%) for pSOFA, 43.3% (95% CI, 43.2%-43.4%) for Phoenix-8, 38.7% (95% CI, 38.6%-38.7%) for PELOD-2, and 28.6% (95% CI, 28.5%-28.7%) for Phoenix-4.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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. These findings support the generalizability of the Phoenix-8 criteria for pediatric sepsis identification across international settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.16305","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T15:00:32Z","timestamp":1780412432000},"page":"e2616305","source":"Crossref","is-referenced-by-count":1,"title":["The Phoenix Criteria and Other Severity Scores in Identifying Pediatric Sepsis"],"prefix":"10.1001","volume":"9","author":[{"given":"Shuhua","family":"He","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack Zhenhe","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence Chi-ngong","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Prince of Wales Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Prince of Wales Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kin Yip","family":"Yeung","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manson Chon In","family":"Kuok","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Wesley Ching Hei","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis Chi Yu","family":"Au","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, China"},{"name":"Department of Paediatrics and Adolescent Medicine, Yan Chai Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin Ying","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tak Wai","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Kin","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Kwong Wah Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Ming","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene Mary","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwok Ming","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanu","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School\/Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh Simon","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lowell","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China"},{"name":"Department of Intensive Care Medicine, Prince of Wales Hospital, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"8","key":"zoi260458r1","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1001\/jama.2024.0179","article-title":"International Consensus Criteria for Pediatric Sepsis and Septic 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