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Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.

Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.
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Rothman M, Levy M, Dellinger RP, Jones SL, Fogerty RL, Voelker KG, Gross B, Marchetti A, Beals J,


Rothman M, Levy M, Dellinger RP, Jones SL, Fogerty RL, Voelker KG, Gross B, Marchetti A, Beals J, (click to view)

Rothman M, Levy M, Dellinger RP, Jones SL, Fogerty RL, Voelker KG, Gross B, Marchetti A, Beals J,

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Journal of critical care 2016 12 0338() 237-244 pii S0883-9441(16)30277-5
Abstract
PURPOSE
Early identification and treatment improve outcomes for patients with sepsis. Current screening tools are limited. We present a new approach, recognizing that sepsis patients comprise 2 distinct and unequal populations: patients with sepsis present on admission (85%) and patients who develop sepsis in the hospital (15%) with mortality rates of 12% and 35%, respectively.

METHODS
Models are developed and tested based on 258 836 adult inpatient records from 4 hospitals. A "present on admission" model identifies patients admitted to a hospital with sepsis, and a "not present on admission" model predicts postadmission onset. Inputs include common clinical measurements and the Rothman Index. Sepsis was determined using International Classification of Diseases, Ninth Revision, codes.

RESULTS
For sepsis present on admission, area under the curves ranged from 0.87 to 0.91. Operating points chosen to yield 75% and 50% sensitivity achieve positive predictive values of 17% to 25% and 29% to 40%, respectively. For sepsis not present on admission, at 65% sensitivity, positive predictive values ranged from 10% to 20% across hospitals.

CONCLUSIONS
This approach yields good to excellent discriminatory performance among adult inpatients for predicting sepsis present on admission or developed within the hospital and may aid in the timely delivery of care.

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