title: Comparison of Sepsis Screening Tools' Ability to Detect Sepsis Accurately.
abstract: BACKGROUND
  Sepsis is the primary cause of perioperative mortality among general surgery patients and is the leading cause of death in non-cardiac intensive care units. To address this issue, the Surviving Sepsis Campaign Guidelines advocate for sepsis screening. However, there is little information in the current medical literature to suggest which sepsis screening tool is optimal. The purpose of this study was to compare a sepsis screening tool that we have validated and published previously, the Sepsis Screening Score (SSS), with a commercially available sepsis screening tool, the St. John's Sepsis Agent (SJSA) developed by Cerner (Kansas City, MO).
  
  
  METHODS
  This prospective observational study compares the accuracy of the SSS with that of the SJSA in the same patient population. The SSS was performed on each patient in our surgical intermediate care unit (SIMU) twice daily. The SJSA monitored these same patients continuously via the electronic medical record (EMR). Epidemiologic data related to sepsis were collected prospectively, and the performance characteristics of the two tests were compared using the two-sample test of proportions.
  
  
  RESULTS
  A total of 348 patients were included in the study, and 47 (13.5%) of these patients developed sepsis. The SJSA was determined to have a sensitivity of 44.7%, a specificity of 84.7%, a positive predictive value (PPV) of 31.3%, and a negative predictive value (NPV) of 90.7%, while the SSS was determined to have a sensitivity of 74.5%, a specificity of 86.4%, a PPV of 46.1%, and an NPV of 95.6%. The differences in sensitivity (p < 0.001), PPV (p < 0.001), and NPV (p = 0.011) were found to be statistically significant.
  
  
  CONCLUSIONS
  Despite the fact that SJSA had constant surveillance over patients' EMRs, it still detected fewer septic patients than the SSS, which was performed twice per day. The difference in sensitivities and NPVs between the two tests is of particular importance, because this indicates that the SSS is more effective in identifying patients with sepsis. This study establishes a basis for the utilization of the SSS instead of the SJSA.
authors.affiliation: 1 The University of Texas Health Science Center at Houston , Houston, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Wawrose
authors.affiliation: 1 The University of Texas Health Science Center at Houston , Houston, Texas.
authors.forename: Mary
authors.initials: M
authors.lastname: Baraniuk
authors.affiliation: 2 Memorial Hermann Hospital , Houston, Texas.
authors.forename: Lauren
authors.initials: L
authors.lastname: Standiford
authors.affiliation: 1 The University of Texas Health Science Center at Houston , Houston, Texas.
authors.forename: Charles
authors.initials: C
authors.lastname: Wade
authors.affiliation: 1 The University of Texas Health Science Center at Houston , Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
authors.affiliation: 1 The University of Texas Health Science Center at Houston , Houston, Texas.
authors.forename: Laura
authors.initials: L
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D012720:Severity of Illness Index