P PHOENIX SEPSIS SCORE

* **Study Title:** Phoenix Sepsis Score: Predictive Accuracy for Clinical Deterioration in Pediatric Critical Care * **Authors:** Hadzhieva-Hristova A, Krumova D, Halilova M, Tsotchev K, Karamfilova T, Deyanova Y, Zlateva T, Bazdarska Y, Stoeva T, Iotova V * **Institutions:** * Medical University of Varna * St. Marina University Hospital --- ### **Background** * Early detection of **pediatric sepsis complications** in intensive care is difficult. * Existing scoring systems: * **PRISM III** * **PELOD-2** * **pSOFA** * **Phoenix Sepsis Score (PSS)** * Objective: Compare predictive accuracy of PSS with other scores for identifying clinical deterioration in PICU patients. --- ### **Methods** * **Study design:** Prospective data collection * **Population:** 53 children (June 2022 – January 2024) * Septic: 42 * Non-infectious SIRS: 11 * Outcomes: With complications (23) / Without complications (30) * **Assessment:** * Scoring systems evaluated for **discrimination** and **calibration** * Recalibration performed for PSS * Predictive power assessed via **Area Under Precision-Recall Curve (AUPRC)** --- ### **Results** * **Common complications:** * Respiratory: 18.8% * Neurological: 9.4% * **Clinical deterioration:** 43.4% (including 1 fatality) * **PICU stay:** Longer in patients with complications (14 ± 10 days) * **Score comparisons:** * All scores higher in patients with complications * **Only PSS significant:** p = 0.0023 * **Overall predictive accuracy:** * PSS: 76.2% (highest) * PRISM III: 62.3% * PELOD-2: 58.5% * **pSOFA:** High accuracy (88%) in identifying patients **without complications** * **Precision for complications (AUPRC):** * PSS & PRISM III: 0.62 * **Risk factors:** * Chronic disease: Exp(B) = 1.718 → higher risk * Mechanical ventilation: Exp(B) = 0.509 → lower risk --- ### **Conclusions** * **Phoenix Sepsis Score (PSS)**: * Superior predictive accuracy (76.2%) * Best discriminative capacity for detecting clinical deterioration * Outperformed PRISM III and PELOD-2 in this cohort * Adaptable for **larger-scale validation** in pediatric critical care populations * **

Clinical implication:** PSS can help **early identification of high-risk pediatric patients** and guide timely interventions in the PICU.