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

Authors:
Dr Andrew M Harrison, MD, PhD
Dr Andrew M Harrison, MD, PhD
Mayo Clinic
Postdoctoral researcher
Clinical Informatics
Rochester, MN | United States
Charat Thongprayoon
Charat Thongprayoon
Mayo Clinic
Phoenix | United States
Rahul Kashyap
Rahul Kashyap
Mayo Clinic
United States
Christopher G Chute
Christopher G Chute
Mayo Clinic
United States
Ognjen Gajic
Ognjen Gajic
Mayo Clinic
United States
Brian W Pickering
Brian W Pickering
Mayo Clinic
United States
Vitaly Herasevich
Vitaly Herasevich
Mayo Clinic
United States

Mayo Clin Proc 2015 Feb 6;90(2):166-75. Epub 2015 Jan 6.

Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester MN; Department of Anesthesiology, Mayo Clinic, Rochester MN. Electronic address:

Objective: To develop and test an automated surveillance algorithm (sepsis "sniffer") for the detection of severe sepsis and monitoring failure to 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 severe sepsis/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.

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Source
http://dx.doi.org/10.1016/j.mayocp.2014.11.014DOI Listing

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February 2015
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