A two-step electronic alert system successfully reduced missed sepsis diagnoses in children by 76 percent. The new pediatric protocol, which incorporates the use of vital signs, risk factors, and a clinician’s judgment, shows promise as a sensitive and specific tool that can help pediatricians working in the emergency department (ED) save lives.
Why it matters:
During sepsis, the body produces an overwhelming, inflammatory reaction to infection and damages its own tissues and organs in the process. Though it is the leading cause of deaths in U.S. hospitals, this urgent condition can be hard to identify in children, and it’s often difficult to distinguish from benign causes of fever and tachycardia in non-septic pediatric patients. ED physicians may benefit from an alert system that both adds to, and builds on, existing bedside clinical evaluation. This study is the first to evaluate whether an electronic alert helps to improve accuracy of sepsis identification in children.
Who conducted the study:
The study team included researchers from the Children’s Hospital of Philadelphia’s division of Emergency Medicine, department of Pediatrics, department of Anesthesia and Critical Care, and Office of Clinical Quality Improvement, as well as one researcher from Ann and Robert H. Lurie Children’s Hospital’s division of Emergency Medicine.
How they did it:
Led by Fran Balamuth, MD, attending physician in the division of Emergency Medicine at CHOP, the researchers designed a two-stage electronic sepsis alert (ESA) incorporated into the electronic health record (EHR) at a pediatric hospital. An initial alert goes off when an EHR documents an elevated heart rate or low blood pressure in a child during their emergency visit. If a fever or infection risk is also documented, the system prompts questions about the patient’s mental status, perfusion, and underlying high-risk conditions. A second alert goes off when the system recognizes a positive answer to any of those questions, leading to a “sepsis huddle,” in which the emergency physician gathers with the treatment team for a patient evaluation.
The researchers analyzed a total of 182,509 ED visits during the study period (comparing 86,037 visits before the ESA was implemented, with 96,472 afterwards). Implementing the ESA increased the number of sepsis detections in the ED from 83 percent to 96 percent, and it reduced missed diagnoses by 76 percent.
“This work highlights that an automated vital sign based screen can help to improve sepsis recognition in children, but also underscores the importance of bedside clinical assessment,” Dr. Balamuth said. “We have utilized both types of processes to develop a sepsis recognition program in the CHOP emergency department that is both sensitive and specific. Implementation of this program has resulted in improved identification and treatment of children with sepsis at CHOP.”
The study team is collaborating with other pediatric children’s hospitals, both academic and community centers, to see how the alert performs in other settings.