Media release

From: Murdoch Children's Research Institute (MCRI)

Research at a Glance:

• A Murdoch Children’s Research Institute led study has found more accurate measures are needed to help diagnose children with sepsis as a current clinical tool is failing to detect those requiring hospital care
• The study, using the Phoenix sepsis criteria, found less than 5 per cent of children admitted to hospital with suspected sepsis met the Phoenix Sepsis Score
• The sepsis score identified children with more severe illness and worse outcomes but underestimated the overall burden of disease. Only 1 per cent with a fever had sepsis
• The researchers said the findings would boost awareness of sepsis symptoms and improve quality of life

More accurate measures are needed to help diagnose children with sepsis as a current clinical tool is failing to detect those requiring hospital care, according to a new study.

The research, led by Murdoch Children's Research Institute (MCRI) and published in The Lancet Regional Health - Western Pacific, found less than 5 per cent of children admitted to hospital with suspected sepsis met the Phoenix Sepsis Score.

MCRI Associate Professor Elliot Long said the high rate of missed cases was concerning as access to treatment for sepsis, a life-threatening condition, required immediate medical intervention.

Sepsis is often difficult to diagnose due to its non-specific symptoms, which can mimic other common illnesses. The condition is caused by the body’s extreme response to an infection where the immune system attacks healthy tissue in the body.

Impacting essential organ function, sepsis can lead to serious lung, kidney, liver and heart damage. Every year, about 25 million children are diagnosed with sepsis, resulting in 3 million deaths. The World Health Organization has identified paediatric sepsis as a global health priority.

“Severe infection and sepsis are major causes of childhood death,” Associate Professor Long said. Sepsis must be identified quickly and treatment started urgently to prevent life threatening consequences. But there is limited research into how common sepsis is among children and what symptoms can be used by parents or clinicians to detect sepsis earlier.

“Country-specific sepsis data on incidence and severity has been infrequently and inconsistently reported due to a lack of clear diagnosis guidelines. As a result, the burden of sepsis on healthcare systems is largely unknown”.

To address this, the Society of Critical Care Medicine recently created and validated the Phoenix Sepsis Score.

Associate Professor Long said this was the first study to test and validate the new international sepsis criteria in emergency departments in Australia and New Zealand.

“The findings will be critical to improving sepsis care,” he said. By detailing the incidence, severity, and outcomes of childhood sepsis we can identify gaps in healthcare and improve outcomes.”

The study involved 11 hospitals across Australia and New Zealand in the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, a collaboration of emergency departments, paediatric intense care units and paediatric inpatient wards.

Of the 6232 children aged under 18 years with suspected sepsis, 306 fulfilled Phoenix sepsis criteria. Most of the children were boys, less than five years of age and had underlying health conditions. Only 1 per cent of children with a fever had sepsis.

Associate Professor Long said the Phoenix score failed to detect cases early and underestimated the overall burden of disease.

“The Phoenix criteria didn’t pick up 95 per cent of children hospitalised with sepsis,” he said. This high rate of missed cases is troubling for clinicians, researchers, policymakers and families because it does not tell the whole story.”

The study found 80 per cent of children who fulfilled the sepsis score were admitted to intensive care, almost all required medical interventions such as breathing support and their time in hospital was almost tripled.

“By failing to identify these children much earlier, before being admitted to intensive care, causes delays to treatment and impacts their recovery,” Associate Professor Long said.

Concerning, more than half of the children who died did not fulfil the Phoenix criteria. Overall, 87 patients died within 90 days but just 42 of those met the criteria.

MCRI Professor Franz Babl said the findings would help boost awareness of sepsis symptoms, ensure higher survival rates and improve quality of life.

“We haven’t substantially changed how we manage childhood sepsis in the past 20 years,” he said. There are enormous knowledge gaps in how to best treat sepsis. Some treatments can even cause additional damage to patients, rather than helping them. Patients urgently need safe and effective alternatives.”

Macy, 7, was treated in hospital for a urinary tract infection and sepsis.

Sick with a fever and experiencing pain when urinating, mum Kate took Macy, then 18 months, to their local hospital in search of answers.

“The doctors thought she had a urinary tract infection (UTI), but they decided to halt treatment until that was confirmed,” Kate said. It took about 18 hours for the pathology results to come back, which confirmed their hunch. But due to delays in receiving treatment Macy deteriorated rapidly. Sepsis is a known complication of untreated UTI’s and I was worried things could escalate quickly.”

Kate said overnight Macy’s heart rate elevated and she turned pale and was cold to touch.

“Macy was transferred to The Royal Children’s Hospital where she was given IV fluids and antibiotics to help treat the UTI and sepsis,” she said. It was incredibly scary to watch everything unfold.”

Macy spent a week in hospital before making a full recovery at home.

Kate said the latest MCRI research would help ensure better and more timely care.

“Children must be diagnosed early, no matter what hospital or clinician is overseeing their care,” she said. Something as simple as a UTI can lead to a situation that’s life or death so receiving treatment quickly is vital.”

The research comes as Associate Professor Long was awarded a $5 million Medical Research Future Fund (MRFF) grant to test potential treatments for sepsis through an innovative, adaptive platform trial across Australia and New Zealand.

The trial aims to remove traditional research obstacles by testing and adapting several treatment options for sepsis at once to determine which are most effective.

Publication: Elliot Long, Meredith L Borland, Shane George, Shefali Jani, Eunicia Tan, Natalie Phillips, Amit Kochar, Simon Craig, Anna Lithgow, Arjun Rao, Emma Whyte, Stuart Dalziel, Stephen Hearps, Ben Gelbart, Sarah McNab, Fran Balamuth, Scott L Weiss, Nathan Kuppermann, Amanda Williams and Franz E Babl. ‘Epidemiology of Community Acquired Sepsis in Children in Australia and New Zealand: A Multicentre Prospective Cohort Study,’ The Lancet Regional Health - Western Pacific. DOI: 10.1016/j.lanwpc.2025.101608

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

Available for interview:

Associate Professor Elliot Long, MCRI Team Leader, Emergency Research

Professor Franz Babl, MCRI Group Leader, Emergency Research

Kate, whose daughter Macy, 7, had sepsis

About Murdoch Children’s Research Institute:

Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.