Researchers at Mayo Clinic have developed an algorithm for
sepsis detection based on the new Sepsis-3 definition. Their near real-time
automated Sequential Organ Failure Assessment (SOFA) scoring has strong
agreement with manual score calculation and may be useful for the detection of
sepsis utilising the new Sepsis-3 definition. The study will appear in
International Journal of Medical Informatics.
In early 2016, the Third International Consensus Definitions
for Sepsis and Septic Shock (Sepsis-3) working group released a new operational
definition of sepsis that included a change in SOFA score of at least two
points compared to baseline SOFA score at admission (ΔSOFA). The updated
definitions and clinical criteria were intended to “facilitate earlier
recognition and more timely management of patients with sepsis or at risk of
developing sepsis,” a goal aligned with current Surviving Sepsis Campaign
guidelines.
The Sepsis Definition Task Force also proposed a new score
(qSOFA) to identify patients with sepsis at high risk for bad outcomes outside
of the ICU. The primary advantage of qSOFA is that it can be calculated quickly
and repeatedly at the bedside and without any laboratory tests.
Regardless of which score is used for sepsis screening,
frequent re-scoring imposes a non-trivial time and cognitive burden on
clinicians during the information retrieval and clerical tasks required for
score calculation. Strategies to reduce clinician workload could both aid early
sepsis detection and improve clinical guideline adherence. Computerised
automation is one method to achieve this goal.
For this study, the Mayo team designed a fully automatic
algorithm to calculate the SOFA score in near real-time, prospectively compared
the algorithm performance with standard manual scoring, and developed an
Electronic Health Record (EHR) integrated SOFA automatic score calculator
module to track current and previous SOFA score calculations to assist critical
care clinicians with early sepsis detection.
The team 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. 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 1,206 patient days. Agreement between automatically
scored and manually scored SOFA components for both random spot checks (696
pairs, κ = 0.89) and daily calculation (5,972 pairs, κ = 0.89) was high. 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.
"Our study is not the first attempt at SOFA score
automation, but it is the first to adapt the score for repeated calculation in
near real-time," the authors write. "Our automated SOFA calculator
algorithm can also be utilised at the bedside without extra effort and may
offer a more robust assessment through the inclusion of laboratory data and
more sensitive respiratory information."
However, further studies are needed to prospectively
evaluate the performance of SOFA and qSOFA in early sepsis detection, the
authors said, adding that validated automated calculation methods could be used
in these studies.
Source: International Journal of Medical Informatics