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Early Sepsis Response System Does Not Correlate with Pediatric Early Warning Score in Sepsis Recognition
Jody Huber1,2, Shelley Feng2, Amber Veldman3
1Sanford Children's Hospital, Sanford Medical Center, Sioux Falls, South Dakota.
Insights
A new sepsis alert system in electronic medical records significantly improves early sepsis detection in children compared to existing methods. This sepsis warning system offers better recognition for timely intervention and improved patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Health systems research
Background:
- Sepsis is a major cause of death in children globally, necessitating early detection.
- Electronic medical record (EMR)-based early recognition systems are recommended for pediatric care.
- Existing pediatric early warning scores (PEWS) help identify at-risk children but may not be optimal for sepsis.
Purpose of the Study:
- To develop and evaluate a novel sepsis early response warning system integrated into the EMR.
- To compare the effectiveness of this new system against the generic PEWS in identifying pediatric sepsis.
- To assess the feasibility of implementing such a sepsis alert system in a children's hospital.
Main Methods:
- A novel sepsis early warning system was implemented in the EMR of a tertiary pediatric hospital.
- A best practice alert (BPA) triggered for patients meeting sepsis criteria.
- Data from December 2018 to May 2020 were analyzed, comparing BPA sepsis identification with PEWS scores.
Main Results:
- The BPA triggered for 736 pediatric patients across different hospital units.
- The sepsis criteria identified 71% of these patients (524/736) as having sepsis.
- The existing PEWS identified only 13% (66/524) of sepsis patients identified by the BPA.
Conclusions:
- Implementing a sepsis-specific trigger tool within the EMR is feasible.
- The novel best practice alert system effectively identifies children with early sepsis.
- This sepsis alert system can be integrated into electronic medical records for improved detection.
Abstract:
Sepsis is a leading cause of pediatric morbidity and mortality worldwide with early recognition and management improving patient outcomes. Early recognition warning systems, utilizing the electronic medical record (EMR), are recommended for children's hospitals. Validated pediatric early warning score (PEWS) recognize hospitalized children at risk for worsening and need for higher level of care. The goal of this study was to develop a novel pediatric sepsis early response warning system and compare this tool with the existing generic PEWS system in recognizing sepsis. A novel early sepsis warning system was integrated into the EMR of a tertiary pediatric children's hospital. In patients meeting criteria a best practice alert (BPA) triggers and children with a sepsis BPA trigger were evaluated from December, 2018 through May, 2020. BPA data was analyzed and identified children meeting sepsis criteria. Subjects identified as having sepsis were then correlated with PEWS scores at the time of the BPA. The BPA triggered in 736 pediatric subjects, with 181 in the emergency department, 275 in the pediatric inpatient floor and 280 in the pediatric intensive care unit. Pediatric sepsis criteria identified 524 of 736 (71%) as having sepsis. PEWS scores identified only 66 (13%) of the 524 subjects who had sepsis. Implementation of a sepsis trigger tool into EMR is feasible. Best practice alerts identify subjects with early sepsis and can be implemented to electronic medical record.
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