Assessing the prognostic accuracy of the PSS, pSOFA, and SIRS for in-hospital mortality in children with suspected infection in non-ICU settings: a multicenter retrospective study

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OBJECTIVES: To systematically compare the predictive accuracy of the Phoenix Sepsis Score (PSS), the Pediatric Sequential Organ Failure Assessment (pSOFA), and systemic inflammatory response syndrome (SIRS) in assessing in-hospital mortality risk among pediatric sepsis patients in non-intensive care unit (non-ICU) wards, thereby providing evidence-based support for clinical risk stratification. DESIGN: This study employed a multicenter retrospective cohort design, enrolling non-ICU pediatric patients with suspected infections (excluding preterm infants and neonates hospitalized immediately after birth), to construct an overall cohort and a neonatology subgroup cohort. Clinical parameters were collected through a data acquisition system, with parallel calculations of PSS, pSOFA, and SIRS scores. The primary endpoint was in-hospital mortality. Receiver operating characteristic (ROC) curves were constructed via R language version 4.3.1, and the discriminatory performance of each scoring system was evaluated via the area under the ROC curve (AUROC). RESULTS: From January 2023 to September 2024, 965 non-ICU pediatric patients with infections were enrolled from 13 medical centers (overall cohort mortality: 1.1%, 11/965; neonatology cohort: 193 cases, mortality: 4.1%, 8/193). In the overall cohort, all 11 patients experienced deterioration on the ward and were subsequently transferred to the pediatric intensive care unit (PICU) in accordance with each hospital's protocol; eight of them died from sepsis, and three from septic shock. After multivariate adjustment, the AUROC value of the PSS score in the overall cohort was 0.756 (99% CI: 0.731-0.780), representing a 3.6% improvement over the SIRS criteria (0.730, 99% CI: 0.543-0.873) but lower than the pSOFA score (0.845, 99% CI: 0.568-0.966). In the neonatology cohort, the AUROC value of the PSS score was 0.764 (99% CI: 0.478-0.927), comparable to that of the SIRS criteria (0.757, 99% CI: 0.475-0.905) but still lower than that of the pSOFA score (0.819, 99% CI: 0.533-0.983). No statistically significant differences were observed among the three scoring systems (P > 0.01). CONCLUSIONS: These findings suggest that the PSS score does not demonstrate superior predictive value compared with traditional assessment tools in non-ICU clinical scenarios.

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