Do they know what is sepsis time? Septic Patients Survey Enrolling Staffs study

Comparison of Sepsis Screening Tools' Ability to Detect Sepsis Accurately

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.

CONCLUSION

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.

The impact of duration of organ dysfunction on the outcome of patients with severe sepsis and septic shock

OBJECTIVES

This study aimed to assess the impact of the duration of organ dysfunction on the outcome of patients with severe sepsis or septic shock.

METHODS

Clinical data were collected from hospital charts of patients with severe sepsis and septic shock admitted to a mixed intensive care unit from November 2003 to February 2004. The duration of organ dysfunction prior to diagnosis was correlated with mortality. Results were considered significant if p<0.05.

RESULTS

Fifty-six patients were enrolled. Mean age was 55.6+/-20.7 years, mean APACHE II score was 20.6+/-6.9, and mean SOFA score was 7.9+/-3.7. Thirty-six patients (64.3%) had septic shock. The mean duration of organ dysfunction was 1.9+/-1.9 days. Within the univariate analysis, the variables correlated with hospital mortality were: age (p=0.015), APACHE II (p=0.008), onset outside the intensive care unit (p=0.05), blood glucose control (p=0.05) and duration of organ dysfunction (p=0.0004). In the multivariate analysis, only a duration of organ dysfunction persisting longer than 48 hours correlated with mortality (p=0.004, OR: 8.73 (2.37-32.14)), whereas the APACHE II score remained only a slightly significant factor (p=0.049, OR: 1.11 (1.00-1.23)). Patients who received therapeutic interventions within the first 48 hours after the onset of organ dysfunction exhibited lower mortality (32.1% vs. 82.1%, p=0.0001).

CONCLUSIONS

These findings suggest that the diagnosis of organ dysfunction is not being made in a timely manner. The time elapsed between the onset of organ dysfunction and initiation of therapeutic intervention can be quite long, and this represents an important determinant of survival in cases of severe sepsis and septic shock.