Phoenix Sepsis Score Criteria for Managing Suspected Sepsis
The Phoenix Sepsis Score Criteria use the National Early Warning Score 2 (NEWS2) to stratify risk of mortality and clinical deterioration in adult patients with suspected sepsis, with scores determining monitoring frequency and intervention urgency. 1, 2
NEWS2 Parameters and Scoring
NEWS2 evaluates six physiological parameters, each scored 0-3 points:
Respiratory rate (per minute)
- <8: 3 points
- 9-11: 1 point
- 12-20: 0 points
- 21-24: 2 points
- ≥25: 3 points
Oxygen saturation (SpO₂ Scale 1)
- <91%: 3 points
- 92-93%: 2 points
- 94-95%: 1 point
- ≥96%: 0 points
Oxygen saturation (SpO₂ Scale 2 - for hypercapnic respiratory failure)
- <83%: 3 points
- 84-85%: 2 points
- 86-87%: 1 point
- 88-92%: 0 points
- 93-94%: 1 point
- 95-96%: 2 points
Supplemental oxygen use: 2 points if on oxygen
Systolic blood pressure (mmHg)
- <90: 3 points
- 91-100: 2 points
- 101-110: 1 point
- 111-219: 0 points
- ≥220: 3 points
Pulse rate (per minute)
- <40: 3 points
- 41-50: 1 point
- 51-90: 0 points
- 91-110: 1 point
- 111-130: 2 points
130: 3 points
Level of consciousness
- Alert: 0 points
- CVPU (Confusion, Voice, Pain, Unresponsive): 3 points
Temperature (°C)
- <35.0: 3 points
- 35.1-36.0: 1 point
- 36.1-38.0: 0 points
- 38.1-39.0: 1 point
- ≥39.1: 2 points
Risk Stratification and Monitoring
Based on the total NEWS2 score, patients are categorized into risk levels:
Very low risk (0 points)
- Monitoring: Standard protocol
- Antibiotic timing: As per local protocol
Low risk (1-4 points)
- Monitoring: Every 4-6 hours
- Antibiotic timing: Within 6 hours if sepsis suspected
Moderate risk (5-6 points)
- Monitoring: Every hour
- Antibiotic timing: Within 3 hours if sepsis suspected
High risk (≥7 points)
- Monitoring: Every 30 minutes
- Antibiotic timing: Within 1 hour if sepsis suspected
- Escalate to team responsible for care of acutely ill patients (FY2 level or above)
Special Considerations
A score of 3 in any single parameter may indicate increased risk from sepsis, requiring special attention 1
Consider higher risk than suggested by NEWS2 score if any of the following are present:
- Mottled or ashen appearance
- Non-blanching petechial or purpuric rash
- Cyanosis of skin, lips, or tongue 1
Consider higher risk if condition is deteriorating or has not improved since:
- Previous NEWS2 score calculation
- Any interventions that took place 1
Sequential Monitoring and Reassessment
Reassessment should include:
- Thorough clinical examination
- Evaluation of available physiologic variables (heart rate, blood pressure, oxygen saturation, respiratory rate, temperature, urine output)
- Other noninvasive or invasive monitoring as available 1
Consider further hemodynamic assessment (such as cardiac function) if clinical examination does not lead to clear diagnosis 1
Dynamic variables should be preferred over static variables to predict fluid responsiveness 1
Pitfalls and Caveats
NEWS2 scores should be interpreted in context of the patient's underlying physiology and comorbidities 1, 2
The score is a complement to clinical judgment, not a substitute 2
Some patients may deteriorate rapidly despite a low initial score - clinical judgment should always prevail
For patients with hypercapnic respiratory failure, use SpO₂ Scale 2 which adjusts target saturations to 88-92% 1
While the Phoenix criteria were originally developed for pediatric patients 3, 4, the principles have been adapted for adult use through NEWS2 implementation 1, 2
Monitoring coagulation biomarkers (D-dimer and other markers) is important as sepsis-induced coagulopathy can progress to overt DIC, which significantly increases mortality 1
The Phoenix Sepsis Score Criteria provide a structured approach to identify and manage patients with suspected sepsis, with clear guidance on monitoring frequency and antibiotic timing based on risk stratification.