title: Real-time identification of serious infection in geriatric patients using clinical information system surveillance.
abstract: OBJECTIVE
  To develop and characterize an automated syndromic surveillance mechanism for early identification of older emergency department (ED) patients with possible life-threatening infection.
  
  
  METHODS
  Prospective, consecutive-enrollment, single-site observational study.
  
  
  METHODS
  A large university medical center with an annual ED census of 75,273.
  
  
  METHODS
  Patients aged 70 and older admitted to the ED and having two or more systemic inflammatory response syndrome (SIRS) criteria during their ED stay.
  
  
  METHODS
  A search algorithm was developed to screen the census of the ED through its clinical information system. A study coordinator confirmed all patients electronically identified as having a probable infectious explanation for their visit.
  
  
  RESULTS
  Infection accounted for 28% of ED and 34% of final hospital diagnoses. Identification using the software tool alone carried a 1.63 relative risk of infection (95% confidence interval CI51.09-2.44) compared with other ED patients sufficiently ill to require admission. Follow-up confirmation by a study coordinator increased the risk to 3.06 (95% CI52.11-4.44). The sensitivity of the strategy overall wasmodest (14%), but patients identified were likely to have an infectious diagnosis (specificity 598%). The most common SIRS criterion triggering the electronic notification was the combination of tachycardia and tachypnea.
  
  
  CONCLUSIONS
  A simple clinical informatics algorithm can detect infection in elderly patients in real time with high specificity. The utility of this tool for research and clinical care may be substantial.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, 48109-5303, USA. wmeurer@umich.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Eve D
authors.initials: ED
authors.lastname: Losman
authors.forename: Diana
authors.initials: D
authors.lastname: Sherman
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Yaksich
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Jared
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
authors.forename: John G
authors.initials: JG
authors.lastname: Younger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004636:Emergency Service, Hospital; D005260:Female; D006299:Health Services for the Aged; D006751:Hospital Information Systems; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis*; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*