Automated Sepsis Screening Tool Had Advantages in the Pediatric ED

By Megan Brooks

January 21, 2021

NEW YORK (Reuters Health) - An automated sepsis screening tool embedded in the electronic health record has dramatically increased compliance with sepsis screening in the pediatric emergency department at Boston Children's Hospital and has proven to be more accurate than manual sepsis screening.

"This has the potential to lead to earlier initiation of treatment, which is linked to better outcomes, and to prevent missed sepsis cases, which can have tragic results," Dr. Matthew Eisenberg, director of critical care in the division of emergency medicine at Boston Children's Hospital, told Reuters Health.

"We found it was not only more accurate than the prior manual sepsis screen we were using, but almost effortlessly lets us screen patients for sepsis the entire time they are in our ED, which a manual screening tool cannot do," Dr. Eisenberg, also with Harvard Medical School, said by email.

The Surviving Sepsis Campaign recommends systematic screening of acutely unwell children to ensure timely recognition of septic shock and sepsis-related organ dysfunction.

The American Academy of Pediatrics Pediatric Septic Shock Collaborative has developed a sepsis screening tool for ED use that is "intuitive and easy to use," Dr. Eisenberg and his colleagues note in Pediatrics. But it requires a provider to make an active decision to screen the patient and compare the findings to predetermined normal values to calculate a score, they add.

The advantage of an automated screening tool is that it does not require active initiation by a provider and can screen continuously throughout the ED stay rather than at a single point in time.

Dr. Eisenberg and colleagues did a retrospective study of encounters in Boston Children's Hospital ED over a two-year period. For the first year, manual sepsis screening was done. In the second year, an automated sepsis screening algorithm developed at Boston Children's and embedded in the EHR replaced manual sepsis screening.

During the two-year study, there were 122,221 ED encounters and 273 cases of severe sepsis. After transitioning from manual to automated screening, the proportion of encounters in which sepsis screening was performed jumped from 14.6% to 100%.

During the manual-screening period, nearly all patients were screened once at most during their ED stay, while patients during the automated-alert period underwent continuous sepsis surveillance throughout the ED stay, "allowing the automated tool to better detect patients who clinically deteriorated while in the ED," the researchers note in their paper.

Automated screening also had a higher sensitivity (85% vs. 65%) and specificity (95% vs. 91%) than manual screening. As a result, the percentage of patients with severe sepsis with a positive screen result or alert increased from 45% to 85% after the switch to automated screening.

"There are a number of other children's hospitals that use automated sepsis screening around the country. Some use the tool we described in this study (that we developed at BCH), and others use various other screening tools that utilize different criteria to identify sepsis and work with different electronic medical record systems," Dr. Eisenberg explained.

This research had no external funding and the authors have indicated no conflicts of interest.

SOURCE: Pediatrics, online January 20, 2021.