A targeted real-time early warning score (TREWScore) for septic shock

Katharine E. Henry, David Northrop Hager, Peter J. Pronovost, Suchi Saria

Research output: Contribution to journalArticle

Abstract

Sepsis is a leading cause of death in the United States, with mortality highest among patients who develop septic shock. Early aggressive treatment decreasesmorbidity andmortality. Although automated screening tools can detect patients currently experiencing severe sepsis and septic shock, none predict those at greatest risk of developing shock. We analyzed routinely available physiological and laboratory data from intensive care unit patients and developed "TREWScore," a targeted real-time early warning score that predicts which patients will develop septic shock. TREWScore identified patients before the onset of septic shock with an area under the ROC (receiver operating characteristic) curve (AUC) of 0.83 [95% confidence interval (CI), 0.81 to 0.85]. At a specificity of 0.67, TREWScore achieved a sensitivity of 0.85 and identified patients a median of 28.2 [interquartile range (IQR), 10.6 to 94.2] hours before onset. Of those identified, two-thirds were identified before any sepsis-related organ dysfunction. In comparison, the Modified Early Warning Score, which has been used clinically for septic shock prediction, achieved a lower AUC of 0.73 (95%CI, 0.71 to 0.76). A routine screening protocol based on the presence of two of the systemic inflammatory response syndrome criteria, suspicion of infection, and either hypotension or hyperlactatemia achieved a lower sensitivity of 0.74 at a comparable specificity of 0.64. Continuous sampling of data from the electronic health records and calculation of TREWScore may allow clinicians to identify patients at risk for septic shock and provide earlier interventions that would prevent or mitigate the associated morbidity and mortality.

Original languageEnglish (US)
Article number299ra122
JournalScience Translational Medicine
Volume7
Issue number299
DOIs
StatePublished - Aug 5 2015

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Septic Shock
Sepsis
Area Under Curve
Confidence Intervals
Systemic Inflammatory Response Syndrome
Mortality
Electronic Health Records
ROC Curve
Hypotension
Intensive Care Units
Cause of Death
Shock
Morbidity
Infection

ASJC Scopus subject areas

  • Medicine(all)

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A targeted real-time early warning score (TREWScore) for septic shock. / Henry, Katharine E.; Hager, David Northrop; Pronovost, Peter J.; Saria, Suchi.

In: Science Translational Medicine, Vol. 7, No. 299, 299ra122, 05.08.2015.

Research output: Contribution to journalArticle

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