Effect of a Sepsis Screening Algorithm on Care of Children with False-Positive Sepsis Alerts.

Autor: Baker AH; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA. Electronic address: alexandra.baker@childrens.harvard.edu., Monuteaux MC; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA., Madden K; Division of Critical Care, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesiology, Harvard Medical School, Boston, MA., Capraro AJ; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA., Harper MB; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA., Eisenberg M; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2021 Apr; Vol. 231, pp. 193-199.e1. Date of Electronic Publication: 2021 Jan 27.
DOI: 10.1016/j.jpeds.2020.12.034
Abstrakt: Objectives: To determine if implementation of an automated sepsis screening algorithm with low positive predictive value led to inappropriate resource utilization in emergency department (ED) patients as evidenced by an increased proportion of children with false-positive sepsis screens receiving intravenous (IV) antibiotics.
Study Design: Retrospective cohort study comparing children <18 years of age presenting to an ED who triggered a false-positive sepsis alert during 2 different 5-month time periods: a silent alert period when alerts were generated but not visible to clinicians and an active alert period when alerts were visible. Primary outcome was the proportion of patients who received IV antibiotics. Secondary outcomes included proportion receiving IV fluid boluses, proportion admitted to the hospital, and ED length of stay (LOS).
Results: Of 1457 patients, 1277 triggered a false-positive sepsis alert in the silent and active alert periods, respectively. In multivariable models, there were no changes in the proportion administered IV antibiotics (27.0% vs 27.6%, aOR 1.1 [0.9,1.3]) or IV fluid boluses (29.7% vs 29.1%, aOR 1.0 [0.8,1.2]). Differences in ED LOS and proportion admitted to the hospital were not significant when controlling for similar changes seen across all ED encounters.
Conclusions: An automated sepsis screening algorithm did not lead to changes in the proportion receiving IV antibiotics or IV fluid boluses, department LOS, or the proportion admitted to the hospital for patients with false-positive sepsis alerts.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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