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Effect of a Sepsis Screening Algorithm on Care of Children with False-Positive Sepsis Alerts
Alexandra H Baker1, Michael C Monuteaux1, Kate Madden2
1Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
Insights
An automated sepsis screening algorithm did not increase IV antibiotic or fluid use in children with false-positive alerts. This study found no significant changes in resource utilization for pediatric emergency department patients.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Sepsis Management
Background:
- Automated sepsis screening algorithms aim to improve early detection but may increase false positives.
- Low positive predictive value of sepsis alerts can lead to unnecessary interventions and resource utilization in emergency departments (EDs).
Purpose of the Study:
- To evaluate if an automated sepsis screening algorithm with low positive predictive value resulted in inappropriate resource utilization.
- To assess the impact of a visible sepsis alert on the administration of intravenous (IV) antibiotics and fluid boluses to pediatric patients with false-positive alerts.
Main Methods:
- A retrospective cohort study compared children under 18 presenting to the ED during two 5-month periods: a silent alert period and an active alert period.
- The primary outcome was the proportion of patients receiving IV antibiotics; secondary outcomes included IV fluid boluses, hospital admission rates, and ED length of stay (LOS).
Main Results:
- Of 1457 patients with false-positive sepsis alerts, no significant difference was observed in the proportion receiving IV antibiotics (27.0% vs 27.6%) between the silent and active alert periods.
- Similarly, IV fluid bolus administration (29.7% vs 29.1%), hospital admission rates, and ED LOS did not significantly change when the sepsis alert was visible to clinicians.
Conclusions:
- Implementation of an automated sepsis screening algorithm did not alter the rate of IV antibiotic or fluid administration for pediatric patients with false-positive alerts.
- The study suggests that visible sepsis alerts, even with low positive predictive value, did not lead to increased resource utilization in this pediatric ED population.
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.
