Detecting Sepsis: Are Two Opinions Better Than One?

Bhattacharjee, Poushali; Churpek, Matthew M.; Snyder, Ashley; Howell,; Dp, Edelson

doi:10.12788/jhm.2721

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…However, one study showed that predictions considering ineffective treatment were more valuable when based on collaborative decision-making [ 21 ]. Another study focusing on detecting sepsis showed that the chance of severe sepsis was highest when estimated by two healthcare providers [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality

et al. 2021

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Background Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students’, nurses’, and physicians’ estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up. Methods The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians. Results In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed. Conclusions Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.

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Section: Discussionmentioning

confidence: 99%

The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality

et al. 2021

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“…For example, in a singlecenter prospective study by our group, we found that bedside nurses and ordering providers agreed on the presence of infection only 17% of the time (k ¼ 0.12). 52 Furthermore, progression to severe sepsis or shock was significantly higher when both providers suspected infection in a SIRS-positive patient (17.7%) and lowest when neither suspected infection (1.5%), with singleprovider suspicion conferring intermediate risk (6.0%). Studies using EHR data to define infection are equally challenging, as the accuracy of culture orders, antibiotic prescriptions, and other interventions for defining infection are unknown.…”

Section: Non-sirs-based Screening Toolsmentioning

confidence: 93%

Identifying Patients With Sepsis on the Hospital Wards

Bhattacharjee

Edelson

Churpek

2017

Chest

Self Cite

101

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Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of patients with sepsis in the ED and the ICU; however, many patients acquire sepsis on the general wards. The goal of this review is to discuss recent advances in the detection of sepsis in patients on the hospital wards. We discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score. Challenges specific to detecting sepsis on the wards are discussed, and future directions that use big data approaches and automated alert systems are highlighted.

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“…19 Collaborative care has been shown to improve diagnosis and treatment of various health conditions. [20][21][22][23] A recent workshop recommended that critical care physicians have antimicrobial stewardship as a core competency. 24 However, the recommendation of this group was to incorporate antimicrobial stewardship objectives into critical care training, a daunting task in an already grueling fellowship.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship for sepsis in the intensive care unit: Survey of critical care and infectious diseases physicians

Guillamet

Burnham²,

Pérez³

et al. 2022

Infect. Control Hosp. Epidemiol.

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Objective: To evaluate the attitudes of infectious diseases (ID) and critical care physicians toward antimicrobial stewardship in the intensive care unit (ICU). Design: Anonymous, cross-sectional, web-based surveys. Setting: Surveys were completed in March–November 2017, and data were analyzed from December 2017 to December 2019. Participants: ID and critical care fellows and attending physicians. Methods: We included 10 demographic and 17 newly developed, 5-point, Likert-scaled items measuring attitudes toward ICU antimicrobial stewardship and transdisciplinary collaboration. Exploratory principal components analysis (PCA) was used for data reduction. Multivariable linear regression models explored demographic and attitudinal variables. Results: Of 372 respondents, 315 physicians had complete data (72% attendings, 28% fellows; 63% ID specialists, and 37% critical care specialists). Our PCA yielded a 3-item factor measuring which specialty should assume ICU antimicrobial stewardship (Cronbach standardized α = 0.71; higher scores indicate that ID physicians should be stewards), and a 4-item factor measuring value of ICU transdisciplinary collaborations (α = 0.62; higher scores indicate higher value). In regression models, ID physicians (vs critical care physicians), placed higher value on ICU collaborations and expressed discomfort with uncertain diagnoses. These factors were independently associated with stronger agreement that ID physicians should be ICU antimicrobial stewards. The following factors were independently associated with higher value of transdisciplinary collaboration: female sex, less discomfort with uncertain diagnoses, and stronger agreement with ID physicians as ICU antimicrobial stewards. Conclusions: ID and critical care physicians endorsed their own group for antimicrobial stewardship, but both groups placed high value on ICU transdisciplinary collaborations. Physicians who were more uncomfortable with uncertain diagnoses reported preference for ID physicians to coordinate ICU antimicrobial stewardship; however, physicians who were less uncomfortable with uncertain diagnoses placed greater value on ICU collaborations.

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Detecting Sepsis: Are Two Opinions Better Than One?

Cited by 6 publications

References 13 publications

The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality

The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality

Identifying Patients With Sepsis on the Hospital Wards

Antimicrobial stewardship for sepsis in the intensive care unit: Survey of critical care and infectious diseases physicians

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