Electronic Sepsis Screening Among Patients Admitted to Hospital Wards
Authors: Arabi Yaseen M. , Alsaawi Abdulmohsen , Alzahrani Mohammed , Al Khathaami Ali M. , AlHazme Raed H. , Al Mutrafy Abdullah , Al Qarni Ali , Vishwakarma Ramesh Kumar , Al Anazi Rasha , Al Qasim Eman , Abdukahil Sheryl Ann , Al-Rabeah Fawaz K. , Al Ghamdi Huda , Alatassi Abdulaleem , Al-Dorzi Hasan M. , Al-Hameed Fahad , Babakr Razan , Alghamdi Abdulaziz A. , Bin Salih Salih , Alharbi Ahmad , AlKatheri Mufareh Edah , Mustafa Hani , Al-Qahtani Saad , Al Qahtani Shaher , Alselaim Nahar , Tashkandi Nabiha , Alyami Ali H. , Alyousef Zeyad , AlDibasi Omar , Al-Qahtani Abdul Hadi , Aldawood Abdulaziz , Caswell Angela , Al Ayadhi Nouf , Al Rehaili Hadeel , Al Arfaj Ahmed , Al Mubarak Hatami , Alwasaidi Turki , Zahrani Saleh , Alalawi Yousef , Alhadab Abdulrahman , Nasser Tariq , Omer Tagwa , Al Johani Sameera M. , Alajlan Abdulaziz , Sadat Musharaf , Alzunitan Mohammed , Al Mohrij Saad ,   SCREEN Trial Group and the Saudi Critical Care Trials Group, Al Ghamdi Ebtisam , Al Shammari Haifa , Al Zighaibi Sarah , Al Harbi Fady , Al Kanhel Mohammed , Al Nofaie Saad , Al Moammary Mohamed , Rasheed Soud , Debasi Tariq , Abuelgasim Khadega , Thekair Faisal , Qasim Saleh , Obbed Saeed , Al Onazi Jamila , Alshamrani Majid , Jazieh Abdul Rahman , Al Olayan Ashwaq , Al Harbi Mohamed , Nammour Georges , Jones Joan , Matroud Amal , Hendricks Jacqueline , Jambalos Judelyn , Maake Pauline , Ribeiro Florbela Maria , Panadero Arlene , Al Qarni Mohammed , Jastaniah Wasil , Yamani Arwa , AlMarhabi Hassan , Abuskout Omer , Banat Basem , Matar Eman , Moodi Elizabeth , Naidoo Jayshree , Ghamdi Hala , Habshi Mayadah , Munshi Adnan , Bin Hamdan Abdullah , Swilem Talal , Chalabi Jamal , Lorentziadis Michael , Shahin Mohammed , Yaakob Jamielah , Greyvenstein Johanna , Aliyyen Sami  Musalam , Sian Christa Myumi , Salahaldeen Ahmad , Pienaar Shantal , Al Tuwal Sukaina , Al-Arfaj Waleed K. , Al Qasem Abdulaziz , Al Shouabi Ahmed , Alaraj Abdulatif , Madram Gaber , Nasser Wafa , Al Almoodi Raed , AlSomali Hanan , Masala Clara , Talaqof Fatimah , Al Mostafa Eman , Sharry Mastura , Al Mulhim Maryam , Alhasani Amar , Qureshi Ahmad , Anis Muhammad , Jaber Ibrahim , Omaish Noha , Abd Rahim Azurahazri , Alharbi Basmah , AlMughamisi Naif 
Published: December 2024

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 &amp;lt; .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.

Trial Registration

ClinicalTrials.gov Identifier: NCT04078594