Nelson Textbook of Pediatrics 22nd Edition — Chapter 85 | Four-organ system model (respiratory, cardiovascular, coagulation, neurologic) for pediatric sepsis and septic shock. Points-based scoring for organ dysfunction. Sepsis = suspected infection + Phoenix Sepsis Score ≥2 points. Septic shock = sepsis + ≥1 cardiovascular point(s).
🌐 paeds.online — Pakistan's Pediatric Platform| Organ System | 0 points | 1 point | 2 points | 3 points |
|---|---|---|---|---|
| Respiratory (0-3 points) | PaO₂:FiO₂ ≥400 or SpO₂:FiO₂ ≥292 | PaO₂:FiO₂ <400 on any respiratory support OR SpO₂:FiO₂ <292 on any respiratory support | PaO₂:FiO₂ 100-200 and IMV OR SpO₂:FiO₂ 148-220 and IMV | PaO₂:FiO₂ <100 and IMV OR SpO₂:FiO₂ <148 and IMV |
| Cardiovascular (0-6 points) | 1 point each (up to 3 points): Vasoactive medication (any dose) — 1 point per medication, max 3 points. 2 points each (up to 6 points): Lactate ≥5 mmol/L (2 points), ≥11 mmol/L (additional points). Also age-based mean arterial pressure thresholds (points for low BP). |
≥2 vasoactive medications + lactate elevation → up to 6 points | ||
| Coagulation (0-2 points) | Platelets ≥100 × 10³/μL, INR ≤1.3, D-dimer ≤2 mg/L FEU, fibrinogen ≥100 mg/dL | 1 point each (max 2 points): Platelets <100 × 10³/μL OR INR >1.3 OR D-dimer >2 mg/L FEU OR fibrinogen <100 mg/dL | ||
| Neurologic (0-2 points) | GCS >10, pupils reactive | 2 points: GCS ≤10 OR fixed pupils bilaterally | ||