title: Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.
abstract: Early identification and treatment improve outcomes for patients with sepsis. Current screening tools are limited. We present a new approach, recognizing that sepsis patients comprise 2 distinct and unequal populations: patients with sepsis present on admission (85%) and patients who develop sepsis in the hospital (15%) with mortality rates of 12% and 35%, respectively.
  
  
  
  Models are developed and tested based on 258 836 adult inpatient records from 4 hospitals. A "present on admission" model identifies patients admitted to a hospital with sepsis, and a "not present on admission" model predicts postadmission onset. Inputs include common clinical measurements and the Rothman Index. Sepsis was determined using International Classification of Diseases, Ninth Revision, codes.
  
  
  
  For sepsis present on admission, area under the curves ranged from 0.87 to 0.91. Operating points chosen to yield 75% and 50% sensitivity achieve positive predictive values of 17% to 25% and 29% to 40%, respectively. For sepsis not present on admission, at 65% sensitivity, positive predictive values ranged from 10% to 20% across hospitals.
  
  
  
  This approach yields good to excellent discriminatory performance among adult inpatients for predicting sepsis present on admission or developed within the hospital and may aid in the timely delivery of care.
authors.affiliation: PeraHealth, Inc, 6302 Fairview Rd, Suite 310, Charlotte, NC, 28203. Electronic address: mrothman@perahealth.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Rothman
authors.affiliation: Alpert Medical School at Brown University, Providence, RI. Electronic address: mitchell_levy@brown.edu.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levy
authors.affiliation: Cooper Medical School of Rowan University, Cooper University Health, Camden, NJ. Electronic address: dellinger-phil@cooperhealth.edu.
authors.forename: R Philip
authors.initials: RP
authors.lastname: Dellinger
authors.affiliation: Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX. Electronic address: sljones2@houstonmethodist.org.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Jones
authors.affiliation: Yale School of Medicine, New Haven, CT. Electronic address: robert.fogerty@yale.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fogerty
authors.affiliation: Sarasota Memorial Hospital, Sarasota, FL. Electronic address: kirk-voelker@smh.com.
authors.forename: Kirk G
authors.initials: KG
authors.lastname: Voelker
authors.affiliation: Riverside Regional Medical Center, Newport News, VA. Electronic address: barry.gross@rivhs.com.
authors.forename: Barry
authors.initials: B
authors.lastname: Gross
authors.affiliation: Rutgers New Jersey Medical School, MedERA, Inc., Newark, NJ. Electronic address: albertmarchetti@yahoo.com.
authors.forename: Albert
authors.initials: A
authors.lastname: Marchetti
authors.affiliation: PeraHealth, Inc, 6302 Fairview Rd, Suite 310, Charlotte, NC, 28203. Electronic address: jbeals@perahealth.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Beals
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D062072:Patient Acuity; D010343:Patient Admission; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
keywords: Rothman Index; Sepsis, predicting sepsis; qSOFA