Appl Clin Inform 2010; 01(04): 394-407
DOI: 10.4338/ACI-2010-09-RA-0054
Research Article
Schattauer GmbH

A Computerized Alert Screening For Severe Sepsis In Emergency Department Patients Increases Lactate Testing But Does Not Improve Inpatient Mortality

T. Berger
1  University of California, Davis, Sacramento, CA
,
A. Birnbaum
2  Jacobi Medical Center, Bronx, NY
,
P. Bijur
3  Albert Einstein College of Medicine
,
G. Kuperman
4  Columbia University, New York Presbyterian Hospital
,
P. Gennis
2  Jacobi Medical Center, Bronx, NY
› Author Affiliations
Further Information

Correspondence to:

Tony Berger, MD, MS
4150 V Street, PSSB, #2100
Sacramento, CA 95817
Phone: 916-734-1376   

Publication History

received: 07 September 2010

accepted: 27 October 2010

Publication Date:
16 December 2017 (online)

 

Summary

Objective: 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.


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Conflicts of interest

None of the listed authors had any financial or personal relationships with any person or organization that might influence or bias the objectivity of the submitted content of this study or its acceptance for publication.


Correspondence to:

Tony Berger, MD, MS
4150 V Street, PSSB, #2100
Sacramento, CA 95817
Phone: 916-734-1376