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Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and
Khalia Ackermann1, Jannah Baker1, Marino Festa2
1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia.
Insights
Computerized clinical decision support (CCDS) systems show promise for early sepsis detection in pediatric, neonatal, and maternal patients. However, research remains limited, highlighting the need for more studies on usability and cost-effectiveness.
Area of Science:
- Medical Informatics
- Pediatric Critical Care
- Neonatal Intensive Care
- Maternal Health
Background:
- Sepsis poses a significant global health burden, particularly affecting pediatric, neonatal, and maternal populations.
- Early sepsis identification is crucial for effective management, driving the development of computerized clinical decision support (CCDS) systems.
Purpose of the Study:
- To systematically review and describe studies on the use and evaluation of CCDS systems for early sepsis detection in pediatric, neonatal, and maternal inpatients.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, Embase, CINAHL, Cochrane, LILACS, Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, PQDT).
- Search strategy included terms for sepsis, clinical decision support, and early detection.
- Two independent reviewers screened titles, abstracts, and full texts, with a third reviewer consulted as needed. Data charting and verification were performed systematically.
Main Results:
- 33 studies were included: 13 pediatric, 18 neonatal, and 2 maternal, with most published after 2011 and a surge from 2017 onwards.
- Pediatric studies primarily focused on sepsis identification accuracy (69%), utilizing diverse clinical criteria.
- Neonatal studies frequently evaluated the Kaiser Permanente early-onset sepsis risk calculator (78%), with a focus on antibiotic outcomes (83%). Usability and cost outcomes were rarely reported.
Conclusions:
- Limited research exists on CCDS systems for early sepsis detection in vulnerable pediatric, neonatal, and maternal populations.
- A consensus definition for pediatric and neonatal sepsis is needed.
- Future research should prioritize the study of usability and cost-related outcomes for CCDS systems.
Background:
Sepsis is a severe condition associated with extensive morbidity and mortality worldwide. Pediatric, neonatal, and maternal patients represent a considerable proportion of the sepsis burden. Identifying sepsis cases as early as possible is a key pillar of sepsis management and has prompted the development of sepsis identification rules and algorithms that are embedded in computerized clinical decision support (CCDS) systems.
Objective:
This scoping review aimed to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of pediatric, neonatal, and maternal inpatients at risk of sepsis.
Methods:
MEDLINE, Embase, CINAHL, Cochrane, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global (PQDT) were searched by using a search strategy that incorporated terms for sepsis, clinical decision support, and early detection. Title, abstract, and full-text screening was performed by 2 independent reviewers, who consulted a third reviewer as needed. One reviewer performed data charting with a sample of data. This was checked by a second reviewer and via discussions with the review team, as necessary.
Results:
A total of 33 studies were included in this review-13 (39%) pediatric studies, 18 (55%) neonatal studies, and 2 (6%) maternal studies. All studies were published after 2011, and 27 (82%) were published from 2017 onward. The most common outcome investigated in pediatric studies was the accuracy of sepsis identification (9/13, 69%). Pediatric CCDS systems used different combinations of 18 diverse clinical criteria to detect sepsis across the 13 identified studies. In neonatal studies, 78% (14/18) of the studies investigated the Kaiser Permanente early-onset sepsis risk calculator. All studies investigated sepsis treatment and management outcomes, with 83% (15/18) reporting on antibiotics-related outcomes. Usability and cost-related outcomes were each reported in only 2 (6%) of the 31 pediatric or neonatal studies. Both studies on maternal populations were short abstracts.
Conclusions:
This review found limited research investigating CCDS systems to support the early detection of sepsis among pediatric, neonatal, and maternal patients, despite the high burden of sepsis in these vulnerable populations. We have highlighted the need for a consensus definition for pediatric and neonatal sepsis and the study of usability and cost-related outcomes as critical areas for future research.
International Registered Report Identifier (Irrid):
RR2-10.2196/24899.
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