title: Comparison of Automated Methods Versus the American Burn Association Sepsis Definition to Identify Sepsis and Sepsis With Organ Dysfunction/Septic Shock in Burn-Injured Adults.
abstract: To develop an algorithm to identify sepsis and sepsis with organ dysfunction/septic shock in burn-injured patients incorporating criteria from the American Burn Association sepsis definition that possesses good test characteristics compared with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9) codes and an algorithm previously validated in nonburn-injured septic patients (Martin et al method). This was a retrospective cohort study of consecutive patients admitted to the burn intensive care unit between January 2008 and March 2015. Of the 4761 admitted, 8.6% (n = 407) met inclusion criteria, of which the case rate for sepsis was 34.2% (n = 139; n = 48 sepsis; n = 91 sepsis with organ dysfunction/septic shock). For sepsis identification, the novel algorithm had an accuracy of 86.0% (95% CI: 82.2-89.2%), sensitivity of 66.9% (95% CI: 59.1-74.7%), and specificity of 95.9% (95% CI: 93.5-98.3%). The novel algorithm had better discrimination (0.81, 95% CI: 0.77-0.86) than the ICD-9 method (0.77, 95% CI: 0.73-0.81), although this was not significant (P = .08). For sepsis with organ dysfunction/septic shock, the novel algorithm plus vasopressors (0.67, 95% CI: 0.63-0.72) and the ICD-9 method (0.63, 95% CI: 0.58-0.68) performed equivocal (P = 0.15) but the Martin method (0.76, 95% CI: 0.71-0.81) had superior discrimination than other methods (P < .01). The novel algorithm is an accurate and simple tool to identify sepsis in the burn cohort with good sensitivity and specificity and equivocal discriminative ability to ICD-9 coding. The Martin method had superior discriminative ability for identifying sepsis with organ dysfunction/septic shock in burn-injured patients than either the novel algorithm plus vasopressors or ICD-9 coding.
authors.affiliation: From the *Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois; †Department of Surgery, Loyola University Medical Center, Maywood, Illinois; ‡Department of Information Technologies, Stritch School of Medicine, Loyola University Chicago, Illinois; §Division of Pulmonary and Critical Care Medicine, Department of Information Technologies, University of Maryland School of Medicine, Baltimore, Maryland; ‖Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland; ¶Division of GI, Tumor and Endocrine Surgery, Department of Surgery and the Mucosal Inflammation Program at the University of Colorado Denver; #Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loyola University Chicago, Illinois; and **Department of Public Health Sciences, Loyola University Chicago, Illinois.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Rech
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mosier
authors.forename: Susan
authors.initials: S
authors.lastname: Zelisko
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Kovacs
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
mesh_terms: D000328:Adult; D002056:Burns / Q000145:classification* / Q000150:complications / Q000175:diagnosis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D038801:International Classification of Diseases; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D018805:Sepsis / Q000145:classification* / Q000175:diagnosis / Q000209:etiology