Evidence map›Paper›PMID 40694817›Full record

ArticleJournal of the American Medical Informatics Association : JAMIA2025

Early clinical evaluation of a vendor developed pediatric artificial intelligence sepsis model in the emergency department.

Swaminathan Kandaswamy, Evan W Orenstein, Naveen Muthu, Andrea McCarter, Nikolay Braykov, Jonathan M Beus, Edwin Ray, Tal Senior, Sara P Brown, Rebekah Carter and 9 more

Abstract readValidation Study
In one paragraph

Article in Journal of the American Medical Informatics Association : JAMIA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Swaminathan KandaswamyPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.ORCID 0000-0003-2109-5769
Evan W OrensteinPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.ORCID 0000-0003-3756-8575
Naveen MuthuPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.
Andrea McCarterInformation Systems & Technology, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Nikolay BraykovInformation Systems & Technology, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Jonathan M BeusPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.
Edwin RayInformation Systems & Technology, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Tal SeniorInformation Systems & Technology, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Sara P BrownInformation Systems & Technology, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Rebekah CarterEmergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
MaryBeth GleesonInformation Systems & Technology, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Hannah ThummelClinical Process Improvement, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
John ChengEmergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Thuy BuiEmergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30329, United States.
Reena BlancoPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.
Kiran HebbarPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.
James FortenberryPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.
Srikant B IyerPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.
Mark V MaiPediatrics, Emory University School of Medicine, Atlanta, GA 30307, United States.ORCID 0000-0003-0346-5818

Funding

Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE)UL1TR002378 · NCATS · EMORY UNIVERSITY · PI Andres J Garcia, Elizabeth O. Ofili · 2017 to 2026
$92.1M
Institutional Career Development CoreKL2TR002381 · NCATS · EMORY UNIVERSITY · PI HENRY M BLUMBERG, Anandi Nayan Sheth · 2017 to 2026
$14.1M
AHRQ HHS R03 HS029417NCATS NIH HHSNIH HHS 5R03HS029417-02NIH HHS KL2TR002381NIH HHS UL1TR002378NLM NIH HHS
6 · The paper itself

Abstract

objectiveTo conduct an independent external validation of an implemented vendor-developed emergency department (ED) pediatric sepsis predictive model. MATERIALS AND

methodsWe performed a retrospective cross-sectional study within 2 ED sites of a large pediatric health system between January 1, 2021 and April 1, 2024. A nurse-facing interruptive alert appeared when the model score exceeded the threshold, triggering clinicians to call a sepsis huddle. We compared model predictive performance with vendor-reported performance using definitions that accounted for model threshold and alert timing in clinical practice. Care processes and patient outcome measures included time to first antibiotics, time to first fluid bolus, 30-day mortality, ED to ICU admission rate, and ICU free days.

resultsThe pre-intervention cohort consisted of 268 102 ED visits with 741 (0.28%) sepsis cases. The post-intervention cohort consisted of 331 061 ED visits with 1114 (0.34%) sepsis cases. Model predictive performance dropped from vendor-reported performance. Mean time to first antibiotic decreased from 112 to 102 minutes (P = .05, 95% confidence interval of difference, -19.1 to 0.1) and time to first bolus decreased by 16.7 minutes (P = .03, 95% confidence interval difference, -31.8 to -1.5) after the intervention. Decreases in 30-day mortality (6% [45/741] to 4% [52/1114]); ED to ICU admissions (87% [646/741] to 84% [941/1114]), and ICU free days (6 to 5) after the intervention did not meet statistical significance. DISCUSSION: Implementing the model led to significant reductions in time to fluid bolus and borderline decreases in time to antibiotics, with non-significant changes in mortality and ICU metrics. When implementing an externally developed model, local workflows, documentation patterns, and patient populations make it challenging to generalize published or reported model performance metrics to real world performance.

conclusionWhen tailoring a vendor-developed pediatric ED sepsis model for real-world usage, predictive performance differed substantially. Post-implementation we found improvements in care process measures, suggesting such models may benefit sepsis care when adapted for specific clinical workflows.

Indexed as

Artificial IntelligenceEmergency Service, HospitalSepsisAnti-Bacterial AgentsChildChild, PreschoolCross-Sectional StudiesFemaleHumansInfantMaleRetrospective StudiesTime-to-TreatmentAnti-Bacterial Agentsclinical evaluationpediatricspredictive modelssepsis

Identifiers

PMID40694817
PMCPMC12451933

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.