BACKGROUND AND PURPOSE:

• There are multiple established sepsis determination models such as SIRS, qSOFA, and SOFA
• A new prediction model, the Sepsis Prediction Model (SPM), a proprietary decision support tool created by Epic Systems, has not yet been evaluated against the established models
• Schertz et al. (JAMA Netw Open, 2023) assessed the validity and timeliness of the SPM compared with SIRS, qSOFA, and SOFA

METHODS:

• Retrospective cohort study
  • 5 US Hospitals within a single system
  • Between June 2019 and December 2020
• Population
  • Adults admitted to US acute care hospitals
• Exposures
  • Sepsis prediction models (SIRS, qSOFA, and SOFA, and SPM)
• Study design
  • Time zero was defined as 15 minutes prior to qualifying antimicrobial or blood culture order
  • Sepsis was defined as receipt of 4 or more days of antimicrobials | Blood cultures collected within ±48 hours of initial antimicrobial | ≥1 organ dysfunction
• Primary outcomes
  • The ability of each of the prediction models to classify sepsis admissions
  • The timeliness of each tool with respect to time zero

RESULTS:

• 60,507 total admissions
  • Met sepsis criteria: 2.7%
• Within the vendor recommended predicting sepsis score (PSS) of 5 to 8, the SPM had the highest balanced accuracy for classifying a sepsis admission with a score of ≥8
• The greatest sensitivity for determining sepsis was achieved with change in SOFA score of ≥2
• Median time to score positivity from time zero varied widely among the different tests
  • At a PSS of ≥8: 68.00 (IQR, 6.75 to 605.75) minutes
  • SIRS: 7.00 (IQR, −105.00 to 08.00) minutes
  • qSOFA: 74.00 (IQR, −22.25 to 599.25) minutes
  • SOFA: 28.00 (IQR, −108.50 to 134.00) minutes

CONCLUSION:

• The balanced accuracy at predicting sepsis was higher for SPM, especially at a higher threshold PSS
• However, SIRS and SOFA both far outperformed SPM for timeliness
• The authors state

In the case of sepsis, prioritization of timely treatment is paramount, given the potentially severe consequences when the diagnosis is missed or delayed

Learn More – Primary Sources:

Sepsis Prediction Model for Determining Sepsis vs SIRS, qSOFA, and SOFA