title: Diagnostic accuracy of a screening electronic alert tool for severe sepsis and septic shock in the emergency department.
abstract: BACKGROUND
  Early recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients.
  
  
  METHODS
  An electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis). This study included all patients older than 14 years who presented to the ED of a tertiary care academic medical center from Oct. 1, 2012 to Jan. 31, 2013. As a comparator, emergency medicine physicians or the critical care physician identified the patients with severe sepsis or septic shock. In the ED, vital signs were manually entered into the hospital electronic heath record every hour in the critical care area and every two hours in other areas. We also calculated the time from the alert to the intensive care unit (ICU) referral.
  
  
  RESULTS
  Of the 49,838 patients who presented to the ED, 222 (0.4%) were identified to have severe sepsis or septic shock. The electronic sepsis alert had a sensitivity of 93.18% (95% CI, 88.78% - 96.00%), specificity of 98.44 (95% CI, 98.33% - 98.55%), positive predictive value of 20.98% (95% CI, 18.50% - 23.70%) and negative predictive value of 99.97% (95% CI, 99.95% - 99.98%) for severe sepsis and septic shock. The alert preceded ICU referral by a median of 4.02 hours (Q1 - Q3: 1.25-8.55).
  
  
  CONCLUSIONS
  Our study shows that electronic sepsis alert tool has high sensitivity and specificity in recognizing severe sepsis and septic shock, which may improve early recognition and management.
authors.affiliation: Emergency Medicine and Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. SolamyS@ngha.med.sa.
authors.forename: Sami
authors.initials: S
authors.lastname: Alsolamy
authors.affiliation: Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. SalamahM@ngha.med.sa.
authors.forename: Majid
authors.initials: M
authors.lastname: Al Salamah
authors.affiliation: Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. althagafima@ngha.med.sa.
authors.forename: Majed
authors.initials: M
authors.lastname: Al Thagafi
authors.affiliation: Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. aldorzih@yahoo.com.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.affiliation: Quality Management Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. mariniab@ngha.med.sa.
authors.forename: Abdellatif M
authors.initials: AM
authors.lastname: Marini
authors.affiliation: Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. aljerianna@ngha.med.sa.
authors.forename: Nawfal
authors.initials: N
authors.lastname: Aljerian
authors.affiliation: Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. AnaziF2@ngha.med.sa.
authors.forename: Farhan
authors.initials: F
authors.lastname: Al-Enezi
authors.affiliation: King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. alhunaidifa@ngha.med.sa.
authors.forename: Fatimah
authors.initials: F
authors.lastname: Al-Hunaidi
authors.affiliation: Clinical Information Management Systems, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. MahmoudAm@ngha.med.sa.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Mahmoud
authors.affiliation: College of Public Health and Health Informatics and Quality Management & Consultant of Emergency Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. amryah@ngha.med.sa.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alamry
authors.affiliation: King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. yaseenarabi@yahoo.com.|Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, Mail code 1425, Riyadh, 11426, Saudi Arabia. yaseenarabi@yahoo.com.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
mesh_terms: D000328:Adult; D019091:Critical Pathways; D020000:Decision Support Systems, Clinical; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D012772:Shock, Septic / Q000175:diagnosis; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*