Electronic Sepsis Screening Among Patients Admitted to Hospital Wards

被引：2

作者：

Arabi, Yaseen M. ^{[1
,2
,3
]}

Alsaawi, Abdulmohsen ^{[2
,3
,4
]}

Alzahrani, Mohammed ^{[5
,6
,7
]}

Al Khathaami, Ali M. ^{[2
,3
,8
]}

Alhazme, Raed H. ^{[2
,9
,10
]}

Al Mutrafy, Abdullah ^{[2
,3
,4
]}

Al Qarni, Ali ^{[11
,12
,13
]}

Vishwakarma, Ramesh Kumar ^{[14
,15
]}

Al Anazi, Rasha ^{[2
,16
]}

Al Qasim, Eman ^{[1
,2
,3
]}

Abdukahil, Sheryl Ann ^{[1
,2
,3
]}

Al-Rabeah, Fawaz K. ^{[2
,9
,10
]}

Al Ghamdi, Huda ^{[2
,9
,10
]}

Alatassi, Abdulaleem ^{[2
,3
,8
]}

Al-Dorzi, Hasan M. ^{[1
,2
,3
]}

Al-Hameed, Fahad ^{[6
,7
,17
]}

Babakr, Razan ^{[18
]}

Alghamdi, Abdulaziz A. ^{[12
,13
,19
]}

Bin Salih, Salih ^{[2
,3
,20
]}

Alharbi, Ahmad ^{[2
,3
,21
]}

Alkatheri, Mufareh Edah ^{[2
,3
,8
]}

Mustafa, Hani ^{[12
,13
,22
]}

Al-Qahtani, Saad ^{[1
,2
,3
]}

Al Qahtani, Shaher ^{[23
]}

Alselaim, Nahar ^{[2
,3
,24
]}

Tashkandi, Nabiha ^{[2
,16
]}

Alyami, Ali H. ^{[6
,7
]}

Alyousef, Zeyad ^{[2
,3
,24
]}

Aldibasi, Omar ^{[14
]}

Al-Qahtani, Abdul Hadi ^{[2
,3
,8
]}

Aldawood, Abdulaziz ^{[1
,2
,3
]}

Caswell, Angela ^{[2
,16
]}

Al Ayadhi, Nouf ^{[2
,9
,10
]}

Al Rehaili, Hadeel ^{[2
,9
,10
]}

Al Arfaj, Ahmed ^{[11
,12
,13
]}

Al Mubarak, Hatami ^{[25
]}

Alwasaidi, Turki ^{[26
]}

Zahrani, Saleh ^{[27
]}

Alalawi, Yousef ^{[28
]}

Alhadab, Abdulrahman ^{[2
,3
,4
,29
]}

Nasser, Tariq ^{[6
,7
,30
]}

Omer, Tagwa ^{[6
,31
,32
]}

Al Johani, Sameera M. ^{[2
,3
,33
]}

Alajlan, Abdulaziz ^{[2
,3
,33
]}

Sadat, Musharaf ^{[1
,2
,3
]}

Alzunitan, Mohammed ^{[2
,3
,34
]}

Al Mohrij, Saad ^{[2
,3
,35
]}

机构：

[1] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Intens Care Dept, Riyadh, Saudi Arabia

[2] King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia

[3] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med, Riyadh, Saudi Arabia

[4] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Med Serv, Riyadh, Saudi Arabia

[5] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Med Serv, Jeddah, Saudi Arabia

[6] King Abdullah Int Med Res Ctr, Jeddah, Saudi Arabia

[7] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med, Jeddah, Saudi Arabia

[8] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Qual & Patient Safety Dept, Riyadh, Saudi Arabia

[9] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Informat Technol Dept, Riyadh, Saudi Arabia

[10] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Publ Hlth & Hlth Informat, Riyadh, Saudi Arabia

[11] King Abdulaziz Hosp, Minist Natl Guard Hlth Affairs, Med Serv, Al Hasa, Saudi Arabia

[12] King Abdullah Int Med Res Ctr, Al Hasa, Al Ahsa, Saudi Arabia

[13] King Saud Bin Abdulaziz Univ Hlth Sci, Al Hasa, Saudi Arabia

[14] King Abdullah Int Med Res Ctr, Biostat & Bioinformat Dept, Riyadh, Saudi Arabia

[15] Univ East Anglia, Norwich Med Sch, Norwich Clin Trial Unit, Norwich, England

[16] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Nursing Serv Dept, Riyadh, Saudi Arabia

[17] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Intens Care Dept, Jeddah, Saudi Arabia

[18] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Qual & Patient Safety Dept, Jeddah, Saudi Arabia

[19] Minist Natl Guard Hlth Affairs, Minist Natl Guard Hlth Affairs, Qual & Patient Safety Dept, Al Hasa 31982, Al Ahsa, Saudi Arabia

[20] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Dept Med, Riyadh, Saudi Arabia

[21] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Dept Med, Div Infect Dis, Riyadh, Saudi Arabia

[22] King Abdulaziz Hosp, Minist Natl Guard Hlth Affairs, Dept Med, Al Hasa, Saudi Arabia

[23] Imam Abdulrahman Al Faisal Hosp, Minist Natl Guard Hlth Affairs, Qual & Patient Safety Dept, Dammam, Saudi Arabia

[24] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Dept Surg, Riyadh, Saudi Arabia

[25] Imam Abdulrahman Al Faisal Hosp, Minist Natl Guard Hlth Affairs, Med Serv Dept, Dammam, Saudi Arabia

[26] Prince Mohammed Bin Abdulaziz Hosp, Minist Natl Guard Hlth Affairs, Med Serv Dept, Madinah, Saudi Arabia

[27] Prince Mohammed Bin Abdulaziz Hosp, Minist Natl Guard Hlth Affairs, Qual & Patient Safety Dept, Madinah, Saudi Arabia

[28] Prince Mohammed Bin Abdulaziz Hosp, Minist Natl Guard Hlth Affairs, Dept Med, Madinah, Saudi Arabia

[29] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Dept Oncol, Riyadh, Saudi Arabia

[30] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Dept Med, Jeddah, Saudi Arabia

[31] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Nursing, Jeddah, Saudi Arabia

[32] King Abdul Aziz Med City, Nursing Serv Dept, Riyadh, Saudi Arabia

[33] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Dept Pathol & Lab Med, Riyadh, Saudi Arabia

[34] King Abdul Aziz Med City, Minist Natl Guard Hlth Affairs, Infect Prevent & Control Dept, Riyadh, Saudi Arabia

[35] Minist Natl Guard Hlth Affairs, Hlth Affairs, Riyadh, Saudi Arabia

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2025年 / 333卷 / 09期

关键词：

EARLY NOTIFICATION; RANDOMIZED-TRIAL; SYSTEM; IMPACT; IMPLEMENTATION; THERAPY; ALERT; ICU;

D O I：

10.1001/jama.2024.25982

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Importance Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness. Objective To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients. Design, Setting, and Participants In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021. Intervention An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening. Main Outcomes and Measures The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile. Results Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile. Conclusions and Relevance Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality.

引用

页码：763 / 773

页数：11

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