Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS)to Identify Patients With Sepsis Improve Mortality?

Saranya Seetharaman, Christina Wilson, Mark Landrum, Sonia Qasba, Morgan Katz, Nicholas Ladikos, Jo Ellen Harris, Panagis Galiatsatos, David Mark Yousem, Amy M Knight, David B Pearse, Renee Blanding, Richard G Bennett, Noya Galai, Trish M. Perl, Geetika Sood

Research output: Contribution to journalArticle

Abstract

Purpose: The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS)and evidence of organ dysfunction identified through electronic alerts improves patient mortality. Methods: This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScience TM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC)reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed. Results: Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21)after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience TM Predicted Mortality Risk Score. Female gender (odds ratio [OR]1.31, 95% confidence interval [CI]1.06-1.63)and facility were also independently associated with mortality. Conclusion: The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Systemic Inflammatory Response Syndrome
Sepsis
Mortality
Practice Guidelines
Anti-Bacterial Agents
Electronic Health Records
Bilirubin
Observational Studies
Lactic Acid
Creatinine
Cohort Studies
Heart Rate
Logistic Models
Odds Ratio
Demography
Confidence Intervals
Blood Pressure
Delivery of Health Care

Keywords

  • Best Practice Alert (BPA)
  • Electronic alert
  • Sepsis
  • SIRS
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{44bcad2fe2a14f3c9a76fc7b98e0c956,
title = "Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS)to Identify Patients With Sepsis Improve Mortality?",
abstract = "Purpose: The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS)and evidence of organ dysfunction identified through electronic alerts improves patient mortality. Methods: This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScience TM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC)reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed. Results: Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7{\%}. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21)after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience TM Predicted Mortality Risk Score. Female gender (odds ratio [OR]1.31, 95{\%} confidence interval [CI]1.06-1.63)and facility were also independently associated with mortality. Conclusion: The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.",
keywords = "Best Practice Alert (BPA), Electronic alert, Sepsis, SIRS, Systemic inflammatory response syndrome",
author = "Saranya Seetharaman and Christina Wilson and Mark Landrum and Sonia Qasba and Morgan Katz and Nicholas Ladikos and Harris, {Jo Ellen} and Panagis Galiatsatos and Yousem, {David Mark} and Knight, {Amy M} and Pearse, {David B} and Renee Blanding and Bennett, {Richard G} and Noya Galai and Perl, {Trish M.} and Geetika Sood",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.amjmed.2019.01.032",
language = "English (US)",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS)to Identify Patients With Sepsis Improve Mortality?

AU - Seetharaman, Saranya

AU - Wilson, Christina

AU - Landrum, Mark

AU - Qasba, Sonia

AU - Katz, Morgan

AU - Ladikos, Nicholas

AU - Harris, Jo Ellen

AU - Galiatsatos, Panagis

AU - Yousem, David Mark

AU - Knight, Amy M

AU - Pearse, David B

AU - Blanding, Renee

AU - Bennett, Richard G

AU - Galai, Noya

AU - Perl, Trish M.

AU - Sood, Geetika

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS)and evidence of organ dysfunction identified through electronic alerts improves patient mortality. Methods: This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScience TM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC)reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed. Results: Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21)after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience TM Predicted Mortality Risk Score. Female gender (odds ratio [OR]1.31, 95% confidence interval [CI]1.06-1.63)and facility were also independently associated with mortality. Conclusion: The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.

AB - Purpose: The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS)and evidence of organ dysfunction identified through electronic alerts improves patient mortality. Methods: This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScience TM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC)reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed. Results: Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21)after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience TM Predicted Mortality Risk Score. Female gender (odds ratio [OR]1.31, 95% confidence interval [CI]1.06-1.63)and facility were also independently associated with mortality. Conclusion: The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.

KW - Best Practice Alert (BPA)

KW - Electronic alert

KW - Sepsis

KW - SIRS

KW - Systemic inflammatory response syndrome

UR - http://www.scopus.com/inward/record.url?scp=85064592727&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064592727&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2019.01.032

DO - 10.1016/j.amjmed.2019.01.032

M3 - Article

C2 - 30831065

AN - SCOPUS:85064592727

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

ER -