Diagnostic accuracy of a screening electronic alert tool for severe sepsis and septic shock in the emergency department

BMC Medical Informatics and Decision Making

Research Article

Ahmed M Mahmoud¹  Ahmed Alamry²  Majed Al Thagafi³  Majid Al Salamah³  Nawfal Aljerian³  Sami Alsolamy⁴  Hasan M Al-Dorzi⁵  Farhan Al-Enezi⁵  Fatimah Al-Hunaidi⁶  Yaseen M Arabi⁷  Abdellatif M Marini⁸ 

[1] Clinical Information Management Systems, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;College of Public Health and Health Informatics and Quality Management & Consultant of Emergency Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Emergency Medicine and Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 11426, Riyadh, Saudi Arabia;Quality Management Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;

关键词: Clinical decision support;    Sepsis;    Sensitivity and specificity;    Septic shock;    Emergency department;    Electronic alert;   

DOI  :  10.1186/s12911-014-0105-7

 received in 2014-01-05, accepted in 2014-11-03,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundEarly recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients.MethodsAn electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis). This study included all patients older than 14 years who presented to the ED of a tertiary care academic medical center from Oct. 1, 2012 to Jan. 31, 2013. As a comparator, emergency medicine physicians or the critical care physician identified the patients with severe sepsis or septic shock.In the ED, vital signs were manually entered into the hospital electronic heath record every hour in the critical care area and every two hours in other areas. We also calculated the time from the alert to the intensive care unit (ICU) referral.ResultsOf the 49,838 patients who presented to the ED, 222 (0.4%) were identified to have severe sepsis or septic shock. The electronic sepsis alert had a sensitivity of 93.18% (95% CI, 88.78% - 96.00%), specificity of 98.44 (95% CI, 98.33% – 98.55%), positive predictive value of 20.98% (95% CI, 18.50% – 23.70%) and negative predictive value of 99.97% (95% CI, 99.95% – 99.98%) for severe sepsis and septic shock. The alert preceded ICU referral by a median of 4.02 hours (Q1 - Q3: 1.25–8.55).ConclusionsOur study shows that electronic sepsis alert tool has high sensitivity and specificity in recognizing severe sepsis and septic shock, which may improve early recognition and management.

【 授权许可】

Unknown   
© Alsolamy et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.