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A targeted real-time early warning score (TREWScore) for septic shock
Katharine E Henry1, David N Hager2, Peter J Pronovost3
1Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA.
Science Translational Medicine
|August 7, 2015
Summary
A new early warning score, TREWScore, accurately predicts septic shock development in ICU patients. This tool identifies at-risk patients earlier than current methods, enabling timely interventions to reduce mortality.
Area of Science:
- Critical Care Medicine
- Health Informatics
- Biostatistics
Background:
- Sepsis is a major cause of death, with septic shock significantly increasing mortality.
- Current screening tools detect existing severe sepsis or septic shock but do not predict future risk.
- Early intervention is crucial for improving outcomes in sepsis.
Purpose of the Study:
- To develop and validate a real-time early warning score (TREWScore) for predicting septic shock in intensive care unit (ICU) patients.
- To compare the predictive performance of TREWScore against existing clinical scores and protocols.
Main Methods:
- Analysis of routinely collected physiological and laboratory data from ICU patients.
- Development of the TREWScore using machine learning algorithms.
- Validation of TREWScore's predictive accuracy using receiver operating characteristic (ROC) curves.
Main Results:
- TREWScore demonstrated high predictive performance with an area under the ROC curve (AUC) of 0.83.
- The score identified patients at risk for septic shock significantly earlier (median 28.2 hours) compared to existing methods.
- TREWScore achieved a sensitivity of 0.85 at a specificity of 0.67, outperforming the Modified Early Warning Score (AUC 0.73).
Conclusions:
- TREWScore offers a promising tool for early identification of patients at risk of developing septic shock.
- Continuous monitoring and calculation of TREWScore from electronic health records can facilitate timely clinical interventions.
- Earlier interventions guided by TREWScore have the potential to reduce sepsis-related morbidity and mortality.
