Aakre Christopher, Franco Pablo Moreno, Ferreyra Micaela, Kitson Jaben, Li Man, Herasevich Vitaly
Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Department of Critical Care, Mayo Clinic,4500 San Pablo Rd S, Jacksonville, FL 32224, USA; Department of Transplant, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
Int J Med Inform. 2017 Jul;103:1-6. doi: 10.1016/j.ijmedinf.2017.04.001. Epub 2017 Apr 3.
We created an algorithm for automated Sequential Organ Failure Assessment (SOFA) score calculation within the Electronic Health Record (EHR) to facilitate detection of sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) clinical definition. We evaluated the accuracy of near real-time and daily automated SOFA score calculation compared with manual score calculation.
Automated SOFA scoring computer programs were developed using available EHR data sources and integrated into a critical care focused patient care dashboard at Mayo Clinic in Rochester, Minnesota. We prospectively compared the accuracy of automated versus manual calculation for a sample of patients admitted to the medical intensive care unit at Mayo Clinic Hospitals in Rochester, Minnesota and Jacksonville, Florida. Agreement was calculated with Cohen's kappa statistic. Reason for discrepancy was tabulated during manual review.
Random spot check comparisons were performed 134 times on 27 unique patients, and daily SOFA score comparisons were performed for 215 patients over a total of 1206 patient days. Agreement between automatically scored and manually scored SOFA components for both random spot checks (696 pairs, κ=0.89) and daily calculation (5972 pairs, κ=0.89) was high. The most common discrepancies were in the respiratory component (inaccurate fraction of inspired oxygen retrieval; 200/1206) and creatinine (normal creatinine in patients with no urine output on dialysis; 128/1094). 147 patients were at risk of developing sepsis after intensive care unit admission, 10 later developed sepsis confirmed by chart review. All were identified before onset of sepsis with the ΔSOFA≥2 point criterion and 46 patients were false-positives.
Near real-time automated SOFA scoring was found to have strong agreement with manual score calculation and may be useful for the detection of sepsis utilizing the new SEPSIS-3 definition.
我们创建了一种算法，用于在电子健康记录（EHR）中自动计算序贯器官衰竭评估（SOFA）评分，以促进基于脓毒症和脓毒性休克第三次国际共识定义（SEPSIS-3）临床定义的脓毒症检测。我们评估了与手动评分计算相比，近实时和每日自动SOFA评分计算的准确性。
利用可用的EHR数据源开发自动SOFA评分计算机程序，并将其集成到明尼苏达州罗切斯特市梅奥诊所的重症监护重点患者护理仪表板中。我们前瞻性地比较了明尼苏达州罗切斯特市和佛罗里达州杰克逊维尔市梅奥诊所医院医学重症监护病房收治的患者样本中自动计算与手动计算的准确性。使用科恩kappa统计量计算一致性。在人工审核期间将差异原因制成表格。
对27名独特患者进行了134次随机抽查比较，在总共1206个患者日中对215名患者进行了每日SOFA评分比较。随机抽查（696对，κ=0.89）和每日计算（5972对，κ=0.89）的自动评分和手动评分SOFA组件之间的一致性都很高。最常见的差异在于呼吸组件（吸入氧分数检索不准确；200/1206）和肌酐（透析时无尿输出患者的肌酐正常；128/1094）。147名患者在重症监护病房入院后有发生脓毒症的风险，10名后来经病历审查确诊为脓毒症。所有患者在脓毒症发作前均根据ΔSOFA≥2分标准被识别，46名患者为假阳性。
发现近实时自动SOFA评分与手动评分计算有很强的一致性，可能有助于利用新的SEPSIS-3定义检测脓毒症。
