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Analysis of Missed Sepsis Patients in a Pediatric Emergency Department With a Vital Sign-Based Electronic Sepsis
Ellie Souganidis1, Mary Kate Abbadessa2, Brandon Ku2
1From the Division of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, TX.
Insights
Many pediatric sepsis alerts are missed, leading to delayed antibiotics and increased need for critical care. Improving sepsis recognition in emergency departments is crucial for better patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care Medicine
- Health Informatics
Background:
- Electronic sepsis alerts aim to improve early sepsis recognition and treatment in pediatric emergency departments.
- Despite alerts, a significant number of patients meeting sepsis criteria may not receive timely intervention.
Purpose of the Study:
- To characterize patients with missed sepsis diagnoses after implementing an electronic sepsis alert system in a pediatric emergency department.
- To compare characteristics and outcomes of missed sepsis patients versus those treated via the sepsis pathway.
Main Methods:
- Retrospective cohort study conducted over three years in a tertiary care children's hospital emergency department.
- Identified missed sepsis patients based on international consensus criteria and lack of sepsis pathway activation.
- Evaluated patient characteristics, alert positivity, and outcomes including antibiotic timing and vasoactive medication use.
Main Results:
- 53 (5%) of 972 patients were identified as missed sepsis cases.
- Most missed patients (77%) triggered the electronic sepsis alert.
- Missed sepsis patients received antibiotics significantly later and were more likely to require vasoactive medications compared to sepsis pathway patients.
Conclusions:
- Electronic sepsis alerts in pediatric emergency departments often flag patients who are ultimately not treated via the sepsis pathway.
- Missed sepsis diagnoses are associated with delayed antibiotic administration and increased need for escalated care.
- Further strategies are needed to optimize the use of sepsis alerts and ensure timely treatment for all eligible pediatric patients.
Objective:
To characterize the cohort of missed sepsis patients since implementation of an electronic sepsis alert in a pediatric emergency department (ED).
Methods:
Retrospective cohort study in a tertiary care children's hospital ED from July 1, 2014, to June 30, 2017. Missed patients met international consensus criteria for severe sepsis requiring intensive care unit admission within 24 hours of ED stay but were not treated with the sepsis pathway/order set in the ED. We evaluated characteristics of missed patients compared with sepsis pathway patients including alert positivity, prior intensive care unit admission, and laboratory testing via medical record review. Outcomes included timeliness of antibiotic therapy and need for vasoactive medications.
Results:
There were 919 sepsis pathway patients and 53 (5%) missed patients during the study period. Of the missed patients, 41 (77%) had vital signs that flagged the sepsis alert. Of these 41 patients, 13 (32%) had a documented sepsis huddle where the team determined that the sepsis pathway was not indicated and 28 (68%) had no sepsis alert-related documentation. Missed patients were less likely to receive timely antibiotics (relative risk, 0.4; 95% confidence interval, 0.3-0.7) and more likely to require vasoactive medications (relative risk, 4.3; 95% confidence interval, 2.9-6.5) compared with sepsis patients.
Conclusions:
In an ED with an electronic sepsis alert, missed patients often had positive sepsis alerts but were not treated for sepsis. Missed patients were more likely than sepsis pathway patients to require escalation of care after admission and less likely to receive timely antibiotics.
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