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Published on: December 18, 2010
External validation of the Phoenix Sepsis Score in Singapore: a retrospective cohort study
Shu-Ling Chong1,2, Althea Qian Wei Lim3, Qian Wen Sng4
1Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore Chong.Shu-Ling@kkh.com.sg.
Objective:
The Phoenix Sepsis Score (PSS) was derived and validated in 10 healthcare systems internationally. We sought to perform an external validation of the PSS among children with suspected infection in a high-resource country in Asia.
Design:
Retrospective cohort study.
Setting:
A tertiary paediatric hospital in Singapore, between 1 January 2020 and 31 December 2024.
Patients:
Children <18 years old hospitalised with suspected infection who received broad-spectrum intravenous antibiotics.
Interventions:
Application of the PSS. We defined sepsis as PSS ≥2, as per the Phoenix criteria.
Main Outcome Measures:
The main outcome was in-hospital mortality. We described the performance of PSS using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC).
Results:
Among 25 202 children (median age 3.3 years (IQR, 0.7-8.4)) with suspected infection, 13 484 were males (53.5%). 82 (0.3%) children died. There were 660 children (2.6%) with PSS ≥2 and 411 (1.6%) met criteria for septic shock. A PSS ≥2 was associated with a mortality risk of 8.5% (56/660) and predicted for mortality with a sensitivity of 68.3% (95% CI 57.5% to 78.4%) and specificity 97.6% (95% CI 97.4% to 97.8%). PSS had an AUROC of 0.90 (95% CI 0.86 to 0.94) and AUPRC of 0.36 (95% CI 0.24 to 0.47) in our study population, outperforming that of the original cohort.
Conclusions:
A PSS ≥2 was highly specific when predicting mortality among children with suspected infection. Our study confirms that the Phoenix criteria can be used as a data-driven benchmark for sepsis research.
