ArticleApplied clinical informatics2016
Validation of Test Performance and Clinical Time Zero for an Electronic Health Record Embedded Severe Sepsis Alert.
Article in Applied clinical informatics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 16 citations in OpenAlex.
- Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience.Scientific reports · 2022Article
- Modulators Influencing Medication Alert Acceptance: An Explorative Review.Applied clinical informatics · 2022Review
- Evaluation of a Sepsis Alert in the Pediatric Acute Care Setting.Applied clinical informatics · 2021Article
- Design, Implementation, and Validation of a Pediatric ICU Sepsis Prediction Tool as Clinical Decision Support.Applied clinical informatics · 2020Article
- Association of Antibiotics Administration Timing With Mortality in Children With Sepsis in a Tertiary Care Hospital of a Developing Country.Frontiers in pediatrics · 2020Article
- To catch a killer: electronic sepsis alert tools reaching a fever pitch?BMJ quality & safety · 2019Article
- Visualizing Infection Surveillance Data for Policymaking Using Open Source Dashboarding.Applied clinical informatics · 2019Article
- Influencing outcomes with automated time zero for sepsis through statistical validation and process improvement.mHealth · 2019Article
- Information Technology and Acute Kidney Injury: Alerts, Alarms, Bells, and Whistles.Advances in chronic kidney disease · 2017Review
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
bachgroundIncreasing use of EHRs has generated interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have had mixed results due to poor test characteristics, the inability to detect sepsis in a timely fashion and the use of outside software limiting widespread adoption. We describe the development, evaluation and validation of an accurate and timely severe sepsis alert with the potential to impact sepsis management.
objectiveTo develop, evaluate, and validate an accurate and timely severe sepsis alert embedded in a commercial EHR.
methodsThe sepsis alert was developed by identifying the most common severe sepsis criteria among a cohort of patients with ICD 9 codes indicating a diagnosis of sepsis. This alert requires criteria in three categories: indicators of a systemic inflammatory response, evidence of suspected infection from physician orders, and markers of organ dysfunction. Chart review was used to evaluate test performance and the ability to detect clinical time zero, the point in time when a patient develops severe sepsis.
resultsTwo physicians reviewed 100 positive cases and 75 negative cases. Based on this review, sensitivity was 74.5%, specificity was 86.0%, the positive predictive value was 50.3%, and the negative predictive value was 94.7%. The most common source of end-organ dysfunction was MAP less than 70 mm/Hg (59%). The alert was triggered at clinical time zero in 41% of cases and within three hours in 53.6% of cases. 96% of alerts triggered before a manual nurse screen.
conclusionWe are the first to report the time between a sepsis alert and physician chart-review clinical time zero. Incorporating physician orders in the alert criteria improves specificity while maintaining sensitivity, which is important to reduce alert fatigue. By leveraging standard EHR functionality, this alert could be implemented by other healthcare systems.
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