ArticleCritical care (London, England)2016
Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes.
Article in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 101 papers, 6 of them syntheses that pooled it.
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Who cites it
101 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Evaluating Artificial Intelligence for Sepsis Prediction in Emergency Departments: A Systematic Review and Meta Analysis.Journal of medical systems · 2026Pooled it
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis : A Systematic Review.Annals of internal medicine · 2025Pooled it
- Pooled it
- Sepsis prediction, early detection, and identification using clinical text for machine learning: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2022Pooled it
- Accuracy of pancreatic stone protein for the diagnosis of infection in hospitalized adults: a systematic review and individual patient level meta-analysis.Critical care (London, England) · 2021Pooled it
- Sepsis Recognition and Management Gaps in Hospitals: A Post Hoc Analysis of a Subset of Data from the European Sepsis Care Survey.Infectious diseases and therapy · 2026Article
- Interobserver Agreement for Classifying Infections in Emergency Department Patients Using Modified Centers for Disease Control and Prevention Criteria.Open forum infectious diseases · 2026Article
- Clinical Features and 1-Year Prognosis of Patients with Suspected Sepsis and Positive Blood Cultures in the Emergency Department: A Single-Center Retrospective Study.Medicina (Kaunas, Lithuania) · 2026Article
- Article
- Early Antibiotic Therapy in Sepsis Without Shock: A Multimethod Study of Heterogeneous Treatment Effects in ICU Patients.Infectious diseases and therapy · 2026Article
- Temporal trends and social determinants of sepsis knowledge in Brazil: findings from three national cross-sectional surveys.Annals of intensive care · 2026Article
- First impressions, second chances in esophageal perforations: treatment pathways and outcome prediction.Updates in surgery · 2025Article
- Evaluating Compliance and Impact of the Sepsis Six Bundle in the Emergency Department: A Retrospective Cohort Study.Cureus · 2025Article
- Antibiotic therapy for severe bacterial infections.Intensive care medicine · 2025Review
- Mortality and antibiotic timing in deep learning-derived surviving sepsis campaign risk groups: a multicenter study.Critical care (London, England) · 2025Observational
- What can the machine teach us?Intensive care medicine experimental · 2025Article
- Impact of a Sepsis Quality Improvement Initiative on Clinical and Operational Outcomes.Healthcare (Basel, Switzerland) · 2025Article
- Harbingers of sepsis misdiagnosis among pediatric emergency department patients.Diagnosis (Berlin, Germany) · 2025Article
- Unsupervised clustering for sepsis identification in large-scale patient data: a model development and validation study.Intensive care medicine experimental · 2025Article
41 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors.
Funding
Abstract
backgroundSepsis is the focus of national quality improvement programs and a recent public reporting measure from the Centers for Medicare and Medicaid Services. However, diagnosing sepsis requires interpreting nonspecific signs and can therefore be subjective. We sought to quantify interobserver variability in diagnosing sepsis.
methodsWe distributed five case vignettes of patients with suspected or confirmed infection and organ dysfunction to a sample of practicing intensivists. Respondents classified cases as systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, or none of the above. Interobserver variability was calculated using Fleiss' κ for the five-level classification, and for answers dichotomized as severe sepsis/septic shock versus not-severe sepsis/septic shock and any sepsis category (sepsis, severe sepsis, or septic shock) versus not-sepsis.
resultsNinety-four physicians completed the survey. Most respondents (88%) identified as critical care specialists; other specialties included pulmonology (39%), anesthesia (19%), surgery (9%), and emergency medicine (9%). Respondents had been in practice for a median of 8 years, and 90% practiced at academic hospitals. Almost all respondents (83%) felt strongly or somewhat confident in their ability to apply the traditional consensus sepsis definitions. However, overall interrater agreement in sepsis diagnoses was poor (Fleiss' κ 0.29). When responses were dichotomized into severe sepsis/septic shock versus not-severe sepsis/septic shock or any sepsis category versus not-sepsis, agreement was still poor (Fleiss' κ 0.23 and 0.18, respectively). Seventeen percent of respondents classified one of the five cases as severe sepsis/septic shock, 27.7% rated two cases, 33.0% respondents rated three cases, 19.2% rated four cases, and 3.2% rated all five cases as severe sepsis/septic shock. Among respondents who felt strongly confident in their ability to use sepsis definitions (n = 45), agreement was no better (Fleiss' κ 0.28 for the five-category classification, and Fleiss' κ 0.21 for the dichotomized severe sepsis/septic shock classification). Cases were felt to be extremely or very realistic in 74% of responses; only 3% were deemed unrealistic.
conclusionsDiagnosing sepsis is extremely subjective and variable. Objective criteria and standardized methodology are needed to enhance consistency and comparability in sepsis research, surveillance, benchmarking, and reporting.
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