Methods: We used retrospective data from a large urban, tertiary care hospital with a hospital-wide EMR-embedded sepsis screening program (SS). A positive screen leads to a rigorous clinical adjudication and appropriate intervention. We included all patients who screened positive from April 2014- December 2015 (n=2944). We then stratified severe sepsis and septic shock prevalence along with mortality (MORT) by year, screening location (emergency department, inpatient; ED, IP), patient age (<18, 18-64, ≥65), time of alert (7am-7pm or 7pm-7am), number of screening alerts (1 or >1), and the first alert in ≤24 or ≤48 hours of admission.
Results: Overall, among inpatients who screened positive, severe sepsis and septic shock incidences were 29.4% (n=516, MORT 25.6%) and 5.6% (n=99, MORT 52.5%); this was 40.2% (n=710, MORT 19.0%) and 10.3% (n=182, MORT 42.3%) in the ED. While age stratification showed the highest mortality risks in those aged >65, stratification based on the screening alert firing in ≤24 or ≤48 hours of admission was the greatest inpatient screening modifier. Only a minority of alerts fired in ≤24 or ≤48 hours of admission with severe sepsis and septic shock incidences of 31.0% (MORT 20.2%) and 5.3% (MORT 27.3%) ≤24 hours, and 28.9% (MORT 27.4%) and 5.7% (MORT 59.7%) >24 hours after admission. Interestingly, having >1 screening alert (24.3% of cases) coincided with higher severe sepsis mortality: 24.2% and 29.2% for 1 alert versus >1 alert.
Conclusion: From our preliminary unadjusted data it appears that sepsis screening and mortality risk differ based on not only expected patient factors but also organizational factors. In addition to the current discussion on simplifying and standardizing sepsis screening criteria additional analyses should further elucidate the need for subgroup-specific sepsis screening.
K. Mccardle, None
M. Mazumdar, None
G. Patel, None
V. Lopachin, None
A. Glasser, None
S. Lorin, None
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