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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Pediatric SIRS, Sepsis, and Septic Shock Criteria

    Defines the severity of sepsis and septic shock for pediatric patients.

    INSTRUCTIONS

    Note: There is still debate about how to define pediatric sepsis given varying ranges of “normal” vital signs for ages. For patients over 18, please use the Adult SIRS, Sepsis, and Septic Shock Criteria.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Children <18 years old with ≥2 SIRS criteria should be screened for severe sepsis / septic shock.
    • Fever in patients <2-3 months - a different topic of study - requires an extensive sepsis evaluation using a lower temperature threshold (i.e., ≥38C).
      • There is good agreement to do full neonatal fever workups for neonates ≤28 days. However workup and interventions for ages 1-3 months are continually changing and often institution-dependent.
    • These criteria are more debated than the adult criteria. The International Consensus Conference on Pediatric Sepsis (ICCPS) convened in 2005 to create definitions, but vital sign ranges with age make it difficult to come to clear concensus.
    • Lactate is not yet accepted as standard screening tool.
    • Tachycardia and tachypnea are extremely common in mild pediatric illness; these are not as useful in selecting for septic patients. Therefore either a temperature or leukocyte abnormality must be present to meet pediatric SIRS criteria.
    • Others abnormalities are age-specific - Vital Signs (VS), physiologic processes (e.g., urine output), and certain laboratory values.
      • However, there is no consensus on the particular ages - ICCPS experts differ from PALS ranges published by American Heart Association, which differ from many institutional guidelines.
    • ICCPS-defined cut offs differ slightly from adults:
      • Temperature of >38.5C for pediatrics, >38C for adults.
      • Bradycardia included for newborns and neonates.

    Sepsis is a major cause of preventable death in children, with estimated mortality in severe sepsis ranging from 2% in previously well children to 10% in those with significant underlying medical conditions. This is lower than in adult severe sepsis, but still significant.

    SIRS Criteria (? 2 meets SIRS definition, 1 of which must be abnormal temperature or leukocyte count)
    List of Age-Dependent Vital Sign Ranges Available in About Section
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    Sepsis Criteria (SIRS + Source of Infection)
    No
    Yes
    Severe Sepsis Criteria (Sepsis + ? 1 following Dysfunction Criteria)
    Organ Dysfunction Criteria »
    No
    Yes
    Septic Shock Criteria (Sepsis + Cardiovascular Dysfunction)
    Organ Dysfunction Criteria »
    No
    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Brahm Goldstein

    About the Creator

    Brahm Goldstein, MD, is the senior medical director at Baxter Healthcare. He was formerly chief of pediatric critical care and the medical director of the pediatric intensive care unit at the University of Rochester Medical Center, where he also was a professor of medicine. Dr. Goldstein serves on the editorial board of many leading medical and scientific publications and has been on multiple advisory boards for healthcare companies.

    To view Dr. Brahm Goldstein's publications, visit PubMed

    Are you Dr. Brahm Goldstein? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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    Dr. Brahm Goldstein
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