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

Saranya Seetharaman; Christina Wilson; Mark Landrum; Sonia Qasba; Morgan Katz; Nicholas Ladikos; Jo Ellen Harris; Panagis Galiatsatos; David M Yousem; Amy M Knight; David B Pearse; Renee Blanding; Richard Bennett; Noya Galai; Trish M Perl; Geeta Sood

doi:10.1016/j.amjmed.2019.01.032

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

Am J Med. 2019 Jul;132(7):862-868. doi: 10.1016/j.amjmed.2019.01.032. Epub 2019 Mar 2.

Authors

Saranya Seetharaman¹, Christina Wilson², Mark Landrum³, Sonia Qasba⁴, Morgan Katz⁵, Nicholas Ladikos⁴, Jo Ellen Harris⁶, Panagis Galiatsatos⁵, David M Yousem⁷, Amy M Knight⁵, David B Pearse⁵, Renee Blanding⁸, Richard Bennett⁹, Noya Galai¹⁰, Trish M Perl¹¹, Geeta Sood¹²

Affiliations

¹ Johns Hopkins Bayview Medical Center, Baltimore, MD.
² Premier Inc., Charlotte, NC.
³ Howard County General Hospital, Columbia, MD.
⁴ Suburban Hospital, Bethesda, MD.
⁵ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
⁶ Sibley Memorial Hospital, Washington, DC.
⁷ Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD.
⁸ Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
⁹ Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD.
¹⁰ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
¹¹ Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
¹² Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: [email protected].

PMID: 30831065
DOI: 10.1016/j.amjmed.2019.01.032

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.

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

Publication types

Observational Study

MeSH terms

Aged
Anti-Bacterial Agents / therapeutic use
Clinical Alarms*
Electronic Health Records
Female
Humans
Logistic Models
Male
Middle Aged
Multiple Organ Failure / diagnosis
Multiple Organ Failure / drug therapy
Multiple Organ Failure / mortality
Retrospective Studies
Sepsis / diagnosis*
Sepsis / drug therapy
Sepsis / mortality
Systemic Inflammatory Response Syndrome / diagnosis*
Systemic Inflammatory Response Syndrome / drug therapy
Systemic Inflammatory Response Syndrome / mortality

Substances

Anti-Bacterial Agents