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Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department
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Details:
  • Pubmed ID:
    26474032
  • Pubmed Central ID:
    PMC4639443
  • Funding:
    K23 HD 082368/HD/NICHD NIH HHS/United States
    K23 GM110496/GM/NIGMS NIH HHS/United States
    K23 HD082368/HD/NICHD NIH HHS/United States
    K12-HD047349/HD/NICHD NIH HHS/United States
    K12-HL109009/HL/NHLBI NIH HHS/United States
    K23-GM110496/GM/NIGMS NIH HHS/United States
    K12 HL109009/HL/NHLBI NIH HHS/United States
    U54-CK000163/CK/NCEZID CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objectives

    To compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED).

    Methods

    This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared.

    Results

    Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159, and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% CI = 72.1% to 73.4%) and specificity 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity 92.1% (95% CI = 91.7% to 92.4%), and specificity 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment vs. algorithmic alert were 40.3% vs. 2.5% and 99.88 % vs. 99.96%, respectively.

    Conclusions

    The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities.