Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit.
Open accessAbstract
OBJECTIVE: To determine whether automated identification with physician notification of the systemic inflammatory response syndrome in medical intensive care unit patients expedites early administration of new antibiotics or improvement of other patient outcomes in patients with sepsis. DESIGN: : A prospective randomized, controlled, single center study. SETTING: Medical intensive care unit of an academic, tertiary care medical center. PATIENTS: Four hundred forty-two consecutive patients admitted over a 4-month period who met modified systemic inflammatory response syndrome criteria in a medical intensive care unit. INTERVENTION: Patients were randomized to monitoring by an electronic "Listening Application" to detect modified (systemic inflammatory response syndrome) criteria vs. usual care. The listening application notified physicians in real time when modified systemic inflammatory response syndrome criteria were detected, but did not provide management recommendations. MEASUREMENTS AND MAIN RESULTS: The median time to new antibiotics was similar between the intervention and usual care groups when comparing among all patients (6.0 hr vs. 6.1 hr, p = .95), patients with sepsis (5.3 hr vs. 5.1 hr; p = .90), patients on antibiotics at enrollment (5.2 hr vs. 7.0 hr, p = .27), or patients not on antibiotics at enrollment (5.2 hr vs. 5.1 hr, p = .85). The amount of fluid administered following detection of modified systemic inflammatory response syndrome criteria was similar between groups whether comparing all patients or only patients who were hypotensive at enrollment. Other clinical outcomes including intensive care unit length of stay, hospital length of stay, and mortality were not shown to be different between patients in the intervention and control groups. CONCLUSIONS: Realtime alerts of modified systemic inflammatory response syndrome criteria to physicians in one tertiary care medical intensive care unit were feasible and safe but did not influence measured therapeutic interventions for sepsis or significantly alter clinical outcomes.
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Interventional studies using traditional SIRS and SOFA alarm systems have not shown significant changes in clinical outcomes.
“Interventional studies using traditional SIRS and SOFA alarm systems have not shown significant changes in clinical outcomes [48–50].”
From Machine learning for the prediction of sepsis: a systematic review and meta-analysis of diagnostic test accuracy (2020) · cites this paper as [50]
The Abstract (Conclusions) and Results report that this modified-SIRS alert trial did not significantly change measured clinical outcomes, including ICU length of stay and mortality. The cited study tested modified SIRS alerts in one ICU; it does not support the sentence’s reference to SOFA alarm systems. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR 0.90; 95% CI 0.51-1.58).
“A pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR, 0.90; 95% CI, 0.51-1.58)(33-35).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [34]
A pooled analysis of three RCTs did not show a mortality benefit of active sepsis screening (RR 0.90; 95% CI 0.51-1.58).
“A pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR 0.90; 95% CI 0.51–1.58) [33–35].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [34]
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Cites
Bone, R. C., BALK, R. A., Cerra, F. B., Dellinger, R. P., Fein, A. M., Knaus, W. A., Schein, R. M. H., & Sibbald, W. J. (1992) · CHEST Journal · doi:10.1378/chest.101.6.1644 · Cited by 13,192 · see citing works
Early goal-directed therapy in the treatment of severe sepsis and septic shock
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E., & Tomlanovich, M. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010307 · Cited by 10,743 · see citing works
Kumar, A., Roberts, D., Wood, K. E., Light, B., Parrillo, J. E., Sharma, S., Suppes, R., Feinstein, D., Zanotti, S., Taiberg, L., et al. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000217961.75225.e9 · Cited by 6,109 · see citing works
2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E. H., Angus, D. C., Cook, D., Cohen, J., Opal, S. M., Vincent, J., & Ramsay, G. (2003) · Critical Care Medicine · doi:10.1097/01.ccm.0000050454.01978.3b · Cited by 5,976 · see citing works
The epidemiology of sepsis in the United States from 1979 through 2000
Martin, G. S., Mannino, D. M., Eaton, S., & Moss, M. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022139 · Cited by 5,841 · see citing works
Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study
Alberti, C., Brun‐Buisson, C., Burchardi, H., Martin, C. M., Goodman, S. V., Artigas, A., Sicignano, A., Palazzo, M. G. A., Moreno, R. P., Boulmé, R., et al. (2001) · Intensive Care Medicine · doi:10.1007/s00134-001-1143-z · Cited by 976 · see citing works
Gaieski, D. F., Mikkelsen, M. E., Band, R. A., Pines, J. M., Massone, R., Furia, F. F., Shofer, F. S., & Goyal, M. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181cc4824 · Cited by 970 · cited 1× · see citing works
“The mean APACHE II score of 17 in patients enrolled in our trial is lower than many published trials that implemented sepsis bundles (6, 7, 15, 16).”
MethodEpidemiology of sepsis: an update
Angus, D. C., & Wax, R. S. (2001) · Critical Care Medicine · doi:10.1097/00003246-200107001-00035 · Cited by 813 · see citing works
Ferrer, R. (2008) · JAMA · doi:10.1001/jama.299.19.2294 · Cited by 741 · see citing works
Nguyen, H. B., Corbett, S. W., Steele, R., Banta, J., Clark, R. T., Hayes, S. R., Edwards, J., Cho, T. W., & Wittlake, W. A. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000259463.33848.3d · Cited by 555 · see citing works
Before–after study of a standardized hospital order set for the management of septic shock*
Micek, S. T., Roubinian, N. H., Heuring, T., Bode, M., Williams, J. A. S., Harrison, C., Murphy, T., Prentice, D., Ruoff, B. E., & Kollef, M. H. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000241151.25426.d7 · Cited by 372 · see citing works
Sebat, F., Musthafa, A. A., Johnson, D. B., Kramer, A. A., Shoffner, D., Eliason, M., Henry, K., & Spurlock, B. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000287593.54658.89 · Cited by 201 · see citing works
An international sepsis survey: a study of doctors' knowledge and perception about sepsis
Poeze, M., Ramsay, G., Gerlach, H., Rubulotta, F. M., & Levy, M. M. (2004) · Critical Care · doi:10.1186/cc2959 · Cited by 183 · see citing works
Implementation of a real-time computerized sepsis alert in nonintensive care unit patients*
Sawyer, A. M., Deal, E. N., Labelle, A. J., Witt, C., Thiel, S. W., Heard, K., Reichley, R. M., Micek, S. T., & Kollef, M. H. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e318205df85 · Cited by 169 · see citing works
Validation of an electronic surveillance system for acute lung injury
Herasevich, V., Yılmaz, M., Khan, H., Hubmayr, R. D., & Gajic, O. (2009) · Intensive Care Medicine · doi:10.1007/s00134-009-1460-1 · Cited by 164 · see citing works
Salinas, J., Chung, K. K., Mann, E. A., et al. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e31821cb790 · Cited by 152 · see citing works
Prospective Trial of Real-Time Electronic Surveillance to Expedite Early Care of Severe Sepsis
Nelson, J. L., Smith, B. L., Jared, J. D., & Younger, J. G. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.12.008 · Cited by 122 · see citing works
Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis*
Thiel, S. W., Asghar, M. F., Micek, S. T., Reichley, R. M., Doherty, J. A., & Kollef, M. H. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e318196206b · Cited by 111 · see citing works
Funk, D. J., Sebat, F., & Kumar, A. (2009) · Current Opinion in Critical Care · doi:10.1097/mcc.0b013e32832e3825 · Cited by 93 · see citing works
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Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Fleuren, L. M., Klausch, T. L. T., Zwager, C. L., Schoonmade, L. J., Guo, T., Roggeveen, L. F., Swart, E. L., Girbes, A. R. J., Thoral, P., Ercole, A., et al. (2020) · Intensive Care Medicine · doi:10.1007/s00134-019-05872-y · Cited by 755 · see citing works
Shimabukuro, D. W., Barton, C. W., Feldman, M. D., Mataraso, S. J., & Das, R. (2017) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2017-000234 · Cited by 382 · see citing works
Balanced crystalloids versus saline in the intensive care unit. The SALT randomized trial.
Semler, M. W., Wanderer, J. P., Ehrenfeld, J. M., Stollings, J. L., Self, W. H., Siew, E. D., Wang, L., Byrne, D. W., Shaw, A. D., Bernard, G. R., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201607-1345oc · Cited by 249 · see citing works
Self-citationBarton, C., Chettipally, U., Zhou, Y., Jiang, Z., Lynn-Palevsky, A., Le, S., Calvert, J., & Das, R. (2019) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2019.04.027 · Cited by 175 · see citing works
McCoy, A., & Das, R. (2017) · BMJ Open Quality · doi:10.1136/bmjoq-2017-000158 · Cited by 148 · see citing works
Identifying Patients With Sepsis on the Hospital Wards
Bhattacharjee, P., Edelson, D. P., & Churpek, M. M. (2017) · Chest · doi:10.1016/j.chest.2016.06.020 · Cited by 120 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
Downing, N. L., Rolnick, J., Poole, S. F., Hall, E., Wessels, A. J., Heidenreich, P., & Shieh, L. (2019) · BMJ Quality & Safety · doi:10.1136/bmjqs-2018-008765 · Cited by 112 · see citing works
Makam, A. N., Nguyen, O. K., & Auerbach, A. D. (2015) · Journal of Hospital Medicine · doi:10.1002/jhm.2347 · Cited by 99 · see citing works
Rhee, C., Strich, J. R., Chiotos, K., Classen, D. C., Cosgrove, S. E., Greeno, R., Heil, E. L., Kadri, S. S., Kalil, A. C., Gilbert, D. N., et al. (2024) · Clinical Infectious Diseases · doi:10.1093/cid/ciad447 · Cited by 40 · see citing works
Evaluation of the effectiveness of an automated sepsis predictive tool on patient outcomes
Schootman, M., Wiskow, C., Loux, T., Meyer, L., Powell, S., Gandhi, A., & Lacasse, A. (2022) · Journal of Critical Care · doi:10.1016/j.jcrc.2022.154061 · Cited by 17 · see citing works
Lipatov, K., Daniels, C. E., Park, J. G., Elmer, J., Hanson, A. C., Madsen, B. E., Clements, C. M., Gajic, O., Pickering, B. W., & Herasevich, V. (2022) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.09.086 · Cited by 11 · see citing works
Wan, Y.-K. J., Wright, M. C., McFarland, M. M., Dishman, D., Nies, M. A., Rush, A., Madaras-Kelly, K., Jeppesen, A., & Del Fiol, G. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad203 · Cited by 11 · see citing works
- Authors
- Hooper, M. H., Weavind, L., Wheeler, A. P., Martin, J. B., Gowda, S. S., Semler, M. W., Hayes, R. M., Albert, D. W., Deane, N. B., Nian, H., Mathe, J. L., Nadas, A., Sztipanovits, J., Miller, A., Bernard, G. R., & Rice, T. W.
- Affiliations
- Eastern Virginia Medical School (US)
- Vanderbilt University (US)
- Meharry Medical College (US)
- Venue
- Critical Care Medicine
- Published
- 2012-07
- Volume
- 40
- Issue
- 7
- Pages
- 2096-2101
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC4451061
- OpenAlex
- W2094915224
- Semantic Scholar
- 7aa067504500d6f0c25197fa6ac41799ad5fc949
- Cited by
- 121
- References
- 19
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 8 · 2022: 11 · 2021: 7 · 2020: 13 · 2019: 10 · 2018: 8 · 2017: 17 · 2016: 15 · 2015: 7 · 2014: 5 · 2013: 3 · 2012: 4
- FWCI
- 4.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5rc1lm010310-02)
- National Heart, Lung, and Blood Institute (R34HL105869, K23HL081431)
- U.S. National Library of Medicine (1RC1LM010310-01, RC1 LM010310)
- National Center for Research Resources (KL2RR024977, TL1RR024978, UL1RR024975)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- sepsis, early detection, systemic inflammatory response syndrome, electronic monitoring, automated alerts, physician notification, antibiotic administration, medical intensive care unit, fluid administration, mortality, length of hospital stay
- MeSH terms
- Anti-Bacterial Agents, Female, Fluid Therapy, Hospital Information Systems, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Medical Records Systems, Computerized, Hospital Mortality, Sepsis, Early Diagnosis
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