Breakroom Recap: Understanding Pediatric Sepsis and the Phoenix Criteria

Last week’s Breakroom session was an engaging and insightful discussion led by Dr. Anisha Attawala, MD, FAAP, Medical Director, and Kim Conner, BSN, CCDS, CCDS-O, Senior CDI Consultant/Clinical Denials Program Manager. Together, they tackled one of the most complex topics in pediatric and NICU CDI: sepsis documentation and the application of the Phoenix Criteria. 

“Sepsis is one of the leading causes of illness and death in children worldwide—but diagnosing it in kids isn’t straightforward. Unlike adults, children have different developmental baselines, their vital signs vary widely by age, and we often face practical limitations like lab availability. That makes direct application of adult frameworks really challenging.” -Dr. Attawala 

The discussion emphasized why pediatric sepsis cannot be viewed within adult frameworks. Children’s unique physiology, developmental baselines, and variable clinical presentations require a tailored approach. Dr. Attawala highlighted the Phoenix criteria, which prioritize objective organ dysfunction across four systems—respiratory, cardiovascular, coagulation, and neurologic—to bring greater standardization to pediatric sepsis diagnosis.

 

Key takeaways included: 

• Clinical Judgment Matters: Phoenix criteria are not validated for neonates under 37 weeks post-conceptional age, so NICU sepsis diagnosis still relies heavily on clinical suspicion, maternal risk factors, and culture data. 

• Objective & Subjective Documentation: CDI teams must marry objective criteria with clear narrative documentation that reflects clinical context, especially when a child “looks well” but meets sepsis criteria. 

• Early Recognition is Critical: Timely identification, treatment, and accurate documentation directly impact coding, quality benchmarking, and patient outcomes. 

• Provider Education is Key: Clear, linked documentation helps CDI teams capture the true clinical picture and prevent denials. 

“Documentation must bridge the gap—use Phoenix where validated, use neonatal sepsis criteria where Phoenix doesn’t apply, clearly distinguish inherent conditions from sepsis related organ dysfunction, and document both objective thresholds and clinical descriptors.” -Kim Conner 

This session provided a wealth of insight for both CDI and providers, emphasizing the importance of collaboration and precision in documentation. 

For those who missed the live session, you can watch the full conversation here!