Ein Alshaeba Samer, Marhoffer Elizabeth A, Holleck Jürgen L, Theisen-Toupal Jesse, Grimshaw Alyssa A, Gunderson Craig G
Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
Department of Medicine, Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA.
J Gen Intern Med. 2025 May 13. doi: 10.1007/s11606-025-09569-5.
The Surviving Sepsis Campaign strongly recommends that all hospitals screen for sepsis as part of performance improvement. The effect of screening for sepsis on mortality, time to antibiotics, and length of stay is uncertain.
A systematic literature search was conducted using Cochrane Library, Google Scholar, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection from earliest entry to June 1, 2024. We included all randomized controlled studies of any type of alert system to screen adult patients for sepsis. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes were pooled using random effects meta-analysis. Strength of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
In total, we found 7 studies of 3409 patients with sepsis. The pooled odds ratio for mortality for patients randomized to early warning systems was 0.84 (95% CI, 0.60, 1.18). The average time to antibiotics was reported in 4 studies and found to be 0.08 h faster in the screening group (95% CI, - 0.44, 0.28). Length of stay was reported in 4 studies and found to be 0.27 days less in the screening group (95%, - 1.21, 0.66). All differences were non-significant. Overall strength of evidence was low due to risk of bias and imprecision.
Based on the current body of randomized controlled studies, there is insufficient evidence to recommend screening for sepsis. Guidelines should reconsider current recommendations for screening for sepsis.
CRD42024563222.
拯救脓毒症运动强烈建议所有医院将脓毒症筛查作为绩效改进的一部分。脓毒症筛查对死亡率、抗生素使用时间和住院时间的影响尚不确定。
使用Cochrane图书馆、谷歌学术、Ovid Embase、Ovid Medline、Scopus和科学引文索引核心合集进行系统的文献检索，检索时间从最早收录至2024年6月1日。我们纳入了所有使用任何类型警报系统对成年脓毒症患者进行筛查的随机对照研究。使用Cochrane偏倚风险工具评估偏倚风险。使用随机效应荟萃分析汇总结果。使用推荐分级评估、制定和评价（GRADE）系统对证据强度进行评级。
我们总共找到了7项针对3409例脓毒症患者的研究。随机分配到早期预警系统的患者死亡率的合并比值比为0.84（95%置信区间，0.60，1.18）。4项研究报告了抗生素使用的平均时间，发现筛查组快0.08小时（95%置信区间，-0.44，0.28）。4项研究报告了住院时间，发现筛查组少0.27天（95%，-1.21，0.66）。所有差异均无统计学意义。由于存在偏倚风险和不精确性，总体证据强度较低。
基于目前的随机对照研究，没有足够的证据推荐进行脓毒症筛查。指南应重新考虑目前关于脓毒症筛查的建议。
PROSPERO注册编号：CRD42024563222。
