脓毒症筛查工具准确检测脓毒症能力的比较。

Comparison of Sepsis Screening Tools' Ability to Detect Sepsis Accurately.

作者信息

Wawrose Richard, Baraniuk Mary, Standiford Lauren, Wade Charles, Holcomb John, Moore Laura

机构信息

1 The University of Texas Health Science Center at Houston , Houston, Texas.

2 Memorial Hermann Hospital , Houston, Texas.

出版信息

Surg Infect (Larchmt). 2016 Oct;17(5):525-9. doi: 10.1089/sur.2015.069. Epub 2016 Jul 22.

DOI:10.1089/sur.2015.069

PMID:27447053

Abstract

BACKGROUND

Sepsis is the primary cause of perioperative mortality among general surgery patients and is the leading cause of death in non-cardiac intensive care units. To address this issue, the Surviving Sepsis Campaign Guidelines advocate for sepsis screening. However, there is little information in the current medical literature to suggest which sepsis screening tool is optimal. The purpose of this study was to compare a sepsis screening tool that we have validated and published previously, the Sepsis Screening Score (SSS), with a commercially available sepsis screening tool, the St. John's Sepsis Agent (SJSA) developed by Cerner (Kansas City, MO).

METHODS

This prospective observational study compares the accuracy of the SSS with that of the SJSA in the same patient population. The SSS was performed on each patient in our surgical intermediate care unit (SIMU) twice daily. The SJSA monitored these same patients continuously via the electronic medical record (EMR). Epidemiologic data related to sepsis were collected prospectively, and the performance characteristics of the two tests were compared using the two-sample test of proportions.

RESULTS

A total of 348 patients were included in the study, and 47 (13.5%) of these patients developed sepsis. The SJSA was determined to have a sensitivity of 44.7%, a specificity of 84.7%, a positive predictive value (PPV) of 31.3%, and a negative predictive value (NPV) of 90.7%, while the SSS was determined to have a sensitivity of 74.5%, a specificity of 86.4%, a PPV of 46.1%, and an NPV of 95.6%. The differences in sensitivity (p < 0.001), PPV (p < 0.001), and NPV (p = 0.011) were found to be statistically significant.

CONCLUSION

Despite the fact that SJSA had constant surveillance over patients' EMRs, it still detected fewer septic patients than the SSS, which was performed twice per day. The difference in sensitivities and NPVs between the two tests is of particular importance, because this indicates that the SSS is more effective in identifying patients with sepsis. This study establishes a basis for the utilization of the SSS instead of the SJSA.

摘要

背景

脓毒症是普通外科患者围手术期死亡的主要原因，也是非心脏重症监护病房死亡的首要原因。为解决这一问题，拯救脓毒症运动指南提倡进行脓毒症筛查。然而，当前医学文献中几乎没有信息表明哪种脓毒症筛查工具是最佳的。本研究的目的是将我们之前验证并发表的一种脓毒症筛查工具——脓毒症筛查评分（SSS），与一种市售的脓毒症筛查工具——由erner公司（密苏里州堪萨斯城）开发的圣约翰脓毒症检测工具（SJSA）进行比较。

方法

这项前瞻性观察性研究在同一患者群体中比较了SSS和SJSA的准确性。在我们的外科中级护理单元（SIMU）中，每天对每位患者进行两次SSS检测。SJSA通过电子病历（EMR）对这些相同的患者进行持续监测。前瞻性收集与脓毒症相关的流行病学数据，并使用两样本比例检验比较两种检测的性能特征。

结果

共有348例患者纳入研究，其中47例（13.5%）发生脓毒症。SJSA的灵敏度为44.7%，特异度为84.7%，阳性预测值（PPV）为31.3%，阴性预测值（NPV）为90.7%，而SSS的灵敏度为74.5%，特异度为86.4%，PPV为46.1%，NPV为95.6%。发现灵敏度（p < 0.001）、PPV（p < 0.001）和NPV（p = 0.011）的差异具有统计学意义。