Developing the surveillance algorithm for detection of failure to recognize and treat severe sepsis. - PubMed - NCBI

Developing the surveillance algorithm for detection of failure to recognize and treat severe sepsis. - PubMed - NCBI

Mayo Clin Proc. 2015 Feb;90(2):166-75. doi: 10.1016/j.mayocp.2014.11.014. Epub 2015 Jan 6.

Developing the surveillance algorithm for detection of failure to recognize and treat severe sepsis.

Harrison AM1, Thongprayoon C2, Kashyap R3, Chute CG4, Gajic O5, Pickering BW3, Herasevich V6.

Author information

Abstract

OBJECTIVE:

To develop and test an automated surveillance algorithm (sepsis "sniffer") for the detection of severe sepsis and monitoring failureto recognize and treat severe sepsis in a timely manner.

PATIENTS AND METHODS:

We conducted an observational diagnostic performance study using independent derivation and validation cohorts from an electronic medical record database of the medical intensive care unit (ICU) of a tertiary referral center. All patients aged 18 years and older who were admitted to the medical ICU from January 1 through March 31, 2013 (N=587), were included. The criterion standard for severesepsis/septic shock was manual review by 2 trained reviewers with a third superreviewer for cases of interobserver disagreement. Critical appraisal of false-positive and false-negative alerts, along with recursive data partitioning, was performed for algorithm optimization.

RESULTS:

An algorithm based on criteria for suspicion of infection, systemic inflammatory response syndrome, organ hypoperfusion and dysfunction, and shock had a sensitivity of 80% and a specificity of 96% when applied to the validation cohort. In order, low systolic blood pressure, systemic inflammatory response syndrome positivity, and suspicion of infection were determined through recursive data partitioning to be of greatest predictive value. Lastly, 117 alert-positive patients (68% of the 171 patients with severe sepsis) had a delay in recognition and treatment, defined as no lactate and central venous pressure measurement within 2 hours of the alert.

CONCLUSION:

The optimized sniffer accurately identified patients with severe sepsis that bedside clinicians failed to recognize and treat in a timely manner.

Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

PMID:

 

25576199

 

DOI:

 

10.1016/j.mayocp.2014.11.014

[PubMed - indexed for MEDLINE]