Comparison of Screening Tools’ Ability to Detect Sepsis Accurately
Richard Wawrose, The University of Texas Health Science Center at Houston; Mary Baraniuk, The University of Texas Health Science Center at Houston; Lauren Standiford, Memorial Hermann Hospital; Charles Wade, The University of Texas Health Science Center at Houston; John Holcomb, The University of Texas Health Science Center at Houston; Laura Moore, The University of Texas Health Science Center at Houston
Sepsis is still the primary cause of perioperative mortality and the leading cause of death in non-cardiac intensive care units. In order to reduce sepsis related morbidity and mortality, it is crucial that healthcare workers recognize and treat sepsis early. To address this issue, the Surviving Sepsis Campaign guidelines advocate for sepsis screening. However, there is little information in the current medical literature to suggest which sepsis screening tool is optimal. The purpose of this study was to compare a sepsis screening tool that we have previously validated and published, the Sepsis Screening Score (SSS), with a commercially available sepsis screening tool, the St. John’s Sepsis Alert (SJSA) developed by Cerner.Hypothesis:
The SSS can detect sepsis more accurately than the SJSA.Methods:
This prospective observational study compares the accuracy of the SSS with that of the SJSA in the same patient population. The SSS was performed on each patient in our Surgical intermediate care unit (SIMU) twice daily. The SJSA continuously monitored these same patients for sepsis via the EMR. Epidemiologic data related to sepsis were collected prospectively, and the performance characteristics of the two tests were compared using the two-proportion Z-test.Results:
A total of 276 patients (50.4% Male, Average Age = 52.9 (Range 16-100)) were included in the study, and 47 (19.9%) of these patients developed sepsis. Of the septic patients, the sources of infection were 13.3% intra-abdominal, 7% skin/soft tissue, 13% UTI, 18% pneumonia, 14% blood, 4% surgical implant, and 31% culture negative. The performance characteristics of the two tests are displayed in the table.
Despite the fact that SJSA had constant surveillance over patients’ EMRs, it still detected fewer septic patients than the SSS, which was performed twice a day. The difference in sensitivities and NPVs between the two tests is of particular importance, as this indicates that the SJSA is more prone to missing the diagnosis of sepsis. This study establishes a basis for the utilization of the SSS instead of the SJSA.