Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS) to Identify Patients With Sepsis Improve Mortality? - 08/08/19

Doi : 10.1016/j.amjmed.2019.01.032

Saranya Seetharaman, MBBS, MPH ^a, Christina Wilson, DPT, MBA ^b, Mark Landrum, MD ^c, Sonia Qasba, MD, MPH ^d, Morgan Katz, MD, MHS ^e, Nicholas Ladikos, PharmD, BCPS ^d, Jo Ellen Harris, RN ^f, Panagis Galiatsatos, MD, MHS ^e, David M. Yousem, MD, MBA ^g, Amy M. Knight, MD ^e, David B. Pearse, MD ^e, Renee Blanding, MD, MPH ^a,^h, Richard Bennett, MD ^a,ⁱ, Noya Galai, PhD ^j, Trish M. Perl, MD, MSc ^k, Geeta Sood, MD, MSc ^e,^{^⁎}
^a Johns Hopkins Bayview Medical Center, Baltimore, MD
^b Premier Inc., Charlotte, NC
^c Howard County General Hospital, Columbia, MD
^d Suburban Hospital, Bethesda, MD
^e Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
^f Sibley Memorial Hospital, Washington, DC
^g Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
^h Department of Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
ⁱ Department of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD
^j Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
^k Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas

^⁎Requests for reprints should be addressed to Dr. Geeta Sood, Mason F. Lord Building Center Tower, 3rd Floor, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224Mason F. Lord Building Center Tower, 3rd Floor, Johns Hopkins Bayview Medical Center5200 Eastern AvenueBaltimoreMD21224

Abstract

Purpose

The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) and evidence of organ dysfunction identified through electronic alerts improves patient mortality.

Methods

This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScience^TM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC) reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed.

Results

Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21) after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience^TM Predicted Mortality Risk Score. Female gender (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.63) and facility were also independently associated with mortality.

Conclusion

The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.

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Keywords : Best Practice Alert (BPA), Electronic alert, Sepsis, SIRS, Systemic inflammatory response syndrome

Plan

Clinical Significance

	Funding: None.
	Conflicts of Interest: DMY reports royalty income from Elsevier, personal fees from Medicolegal consultant, educational honoraria from the American College of Radiology, and royalties from Analytical Informatics (none which pertain to this work). All other authors report no conflicts.
	Authorship: All authors had access to the data and a role in writing this manuscript.

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Vol 132 - N° 7

P. 862-868 - juillet 2019 Retour au numéro

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Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS) to Identify Patients With Sepsis Improve Mortality? - 08/08/19

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