PURPOSE: To assess the time of detection of systemic inflammatory response syndrome (SIRS), sepsis (S), severe sepsis (SS), multiple organ dysfunction syndrome (MODS) and death by healthcare providers (HP) in comparison to computer software (CS).
METHODS: Seventeen patients admitted to the medical intensive care unit at Hahnemannn University Hospital between March 2003 and January 2005 were randomly selected and monitored by CS developed for CiMeRC (Civilian Medical Response Center) using heart rate, respiratory rate, blood pressure, SpO2 and body temperature for detection of SIRS, S, SS, MODS and death. Electronic medical records were reviewed by HP for the same.
RESULTS: Of 17 patients diagnosed with SIRS, HP detected 11(65%) earlier and 4(24%) later compared to CS. 2(11%) patients did not have documented time of SIRS by CS. 17 patients were diagnosed with S by HP. CS failed to diagnose S as it did not have access to microbiologic results. Of 17 patients diagnosed with SS, HP detected 13(76%) earlier and 3(18%) later compared to CS. 1(6%) patient was diagnosed at the same time. Of 16 patients diagnosed with MODS, HP detected 12(75%) earlier and 0 patients later compared to CS. MODS was not detected by HP in 1(6%) patient, CS in 3(19%) and by both in 1 patient. Of 14 patient deaths, HP documented death earlier in 6(43%) and later in 7(50%) compared to CS. Time of death was not recorded by CS in 1 patient.
CONCLUSION: HP appears to detect SIRS, SS and MODS at an earlier time than CS. Time of death documented is variable between HP and CS. Of note, many patients were already diagnosed with the sepsis continuum before being monitored by CS.
CLINICAL IMPLICATIONS: Patient monitoring by CS could assist HP in detection of the sepsis continuum. However, clinical judgment of HP is able to assimilate a wider variety of inputs like laboratory results and radiographic imaging compared to CS. We are currently developing improved algorithms to address CS limitations.
DISCLOSURE: Priya Bakaya, No Financial Disclosure Information; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Computer software developed for CiMeRC(Civilian Medical Response Center) is not yet approved for clinical purposes.