Appl Clin Inform - A Computerized Alert Screening for Severe Sepsis in Emergency Department Patients Increases Lactate Testing but does not Improve Inpatient Mortality.

Tópicos

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Resumo

JECTIVE: This study tested the hypothesis that lactate testing in ED sepsis patients could be increased using a computer alert that automatically recognizes systemic inflammatory response syndrome (SIRS) criteria and recommends lactate testing in cases of sepsis defined as =2 SIRS criteria plus physician suspicion of infection. Secondary outcomes included the effect of the alert on lactate testing among admitted sepsis patients, the proportion of admitted patients with lactate =4.0 mmol/L identified and the in-patient mortality difference before and after alert implementation.METHODS: After a 6 month pre-alert phase, a computer alert was implemented that computed and displayed abnormal vital signs and white blood cell counts for all patients with >2 SIRS criteria and recommended testing lactate if an infection was suspected. Data for admitted patients was collected electronically on consecutive patients meeting sepsis criteria for 6 months before and 6 months after implementation of the alert.RESULTS: There were a total of 5,796 subjects enrolled. Among all septic patients, lactate testing increased from 5.2% in the pre-alert phase to 12.7% in the alert phase, a 7.5% (95% CI 6.0 to 9.0%) absolute increase in lactate testing, p<0.001. Among the 1,798 admitted patients with sepsis, lactate testing increased from 15.3% to 34.2%, an 18.9% (95% CI 15.0 to 22.8%) absolute increase, p<0.001. Among admitted patients with sepsis, there was a 1.9% (95% CI 0.03 to 3.8%, p = 0.05) increase in absolute number of patients with elevated lactate levels identified and a 0.5% (95% CI -1.6 to 2.6%, p=0.64) decrease in mortality.CONCLUSION: The proportion of ED patients who had lactate tested and the number of admitted patients identified with a lactate level =4.0 mmol/L improved significantly after the implementation of a computer alert identifying sepsis patients with >2 SIRS criteria while mortality among admitted sepsis patients remained unchanged.

Resumo Limpo

jectiv studi test hypothesi lactat test ed sepsi patient increas use comput alert automat recogn system inflammatori respons syndrom sir criteria recommend lactat test case sepsi defin sir criteria plus physician suspicion infect secondari outcom includ effect alert lactat test among admit sepsi patient proport admit patient lactat mmoll identifi inpati mortal differ alert implementationmethod month prealert phase comput alert implement comput display abnorm vital sign white blood cell count patient sir criteria recommend test lactat infect suspect data admit patient collect electron consecut patient meet sepsi criteria month month implement alertresult total subject enrol among septic patient lactat test increas prealert phase alert phase ci absolut increas lactat test p among admit patient sepsi lactat test increas ci absolut increas p among admit patient sepsi ci p increas absolut number patient elev lactat level identifi ci p decreas mortalityconclus proport ed patient lactat test number admit patient identifi lactat level mmoll improv signific implement comput alert identifi sepsi patient sir criteria mortal among admit sepsi patient remain unchang

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