Patient Benefits in the Context of Sepsis-Related AI-Based Clinical Decision Support Systems: Scoping Review

Global digitalization continues to advance, extending its influence into medicine and health care systems worldwide. In recent years, substantial advancements have been made in the research and development of artificial intelligence (AI), raising questions about its potential in medicine. The integration and application of AI in intensive care medicine, particularly in sepsis treatment, presents significant potential for advancing patient outcomes and enhancing patient-relevant benefits. However, a comprehensive and systematic overview of the full spectrum of patient-relevant benefits associated with AI-based clinical decision support systems (CDSS) remains lacking.

This scoping review aimed to identify and categorize evidence on patient-relevant benefits of AI-based CDSS in sepsis care.

Systematic research was conducted in 4 electronic databases: MEDLINE via PubMed, Embase, the ACM Digital Library, and IEEE Xplore. In addition, a comprehensive search on the websites of relevant international organizations, along with a citation search of the included articles, was conducted. Articles were included if they (1) focused on sepsis and (2) described patient-relevant benefits of AI-based CDSS. Articles published between January 1, 2008, and March 2, 2023, were considered for inclusion. Study selection was performed independently by 2 reviewers. The manuscript was drafted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The analysis of the included articles was conducted using the program MAXQDA (VERBI Software GmbH), with systemization finalized in a consensus workshop.

A total of 3368 records were identified across the 4 databases, of which 24 met the inclusion criteria and were included in the scoping review. The additional search on international websites and in reference lists identified 6 more relevant articles, resulting in 30 included studies. Of these, 20 were quantitative, comprising 7 prospective and 13 retrospective designs. In addition, 1 qualitative study, 1 mixed methods study, 6 review articles, and 2 articles from institutional websites were included. Patient-relevant benefits were systematized in six main categories: (1) prediction, (2) earlier treatment and prioritization of high-risk patients, (3) individualized therapy, (4) improved patient outcomes (including improved Sequential Organ Failure Assessment score, reduced length of stay, and reduced mortality), (5) general improvements in care, and (6) reduced readmission rate.

This scoping review underscores the potential of AI-based CDSS to positively impact patient-relevant benefits, particularly in sepsis care, where they demonstrate considerable promise for improving intensive care. However, the majority of the identified studies rely on retrospective database analyses. Future research should focus on validating these findings through prospective studies.