Early Machine-Human Interface around Sepsis Severity Identification: From Diagnosis to Improved Management?

Acta Med Acad. 2018 May;47(1):27-38. doi: 10.5644/ama2006-124.212.

Abstract

Objective: To investigate the statistical measures of the performance of 2 interventions: a) early sepsis identification by a computerized sepsis "sniffer" algorithm (CSSA) in the emergency department (ED) and b) human decision to activate a multidisciplinary early resuscitation sepsis and shock response team (SSRT).

Methods: This study used a prospective and historical cohort study design to evaluate the performance of two interventions.

Intervention: A computerized sepsis sniffer algorithm (CSSA) to aid in early diagnosis and a multidisciplinary sepsis and shock response team (SSRT) to improve patient care by increasing compliance with Surviving Sepsis Campaign (SSC) bundles.

Results: The CSSA yielded a sensitivity of 100% (95% CI, 99.13-100%) and a specificity of 96.2% (95% CI, 95.55-96.45%) to identifying sepsis in the ED (Table 1). The SSRT resource was activated appropriately in 34.1% (86/252) of patients meeting severe sepsis or septic shock criteria; the SSRT was inappropriately activated only three times in sepsis-only patients. In 53% (134/252) of cases meeting criteria for SSRT activation, the critical care team was consulted as opposed to activating the SSRT resource.

Conclusion: Our two-step machine-human interface approach to patients with sepsis utilized an outstandingly sensitive and specific electronic tool followed by more specific human decision-making.

Keywords: Algorithm; Computerized decision support; Sepsis.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Clinical Decision-Making*
  • Critical Care / methods*
  • Decision Making, Computer-Assisted
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Patient Care Team*
  • Prospective Studies
  • Resuscitation*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Sepsis / diagnosis*
  • Sepsis / therapy
  • Severity of Illness Index
  • Shock, Septic / diagnosis
  • Shock, Septic / therapy