Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of patients with sepsis in the ED and the ICU; however, many patients acquire sepsis on the general wards. The goal of this review is to discuss recent advances in the detection of sepsis in patients on the hospital wards. We discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score. Challenges specific to detecting sepsis on the wards are discussed, and future directions that use big data approaches and automated alert systems are highlighted. CHEST 2017; 151(4):898-907 KEY WORDS: clinical decision support systems; sepsis; SIRS; SOFA The incidence of sepsis has been rising over the past decade, and it is one of the most common reasons for hospitalization, with an estimated 1.6 million cases annually in the United States. 1,2 This leads to approximately $20 billion dollars in health-care spending in the United States, which will likely continue to increase as the population ages. Although most prior research has focused on patients in the ICU or ED, up to 50% of patients with sepsis are treated on the hospital wards. Longitudinal trends from observational data suggest that outcomes in patients with sepsis are improving. However, mortality remains as high as 50% for those with septic shock. It has been shown that early interventions, such as appropriate antibiotic therapy, improve outcomes in patients with sepsis, making early diagnosis critical. 8, 9 As such, the Surviving Sepsis Campaign (SSC) has made it their mission to raise sepsis awareness and decrease sepsis-related mortality. 10,11 Still, recognition and treatment of sepsis remain a challenge given that more than one-half of patients with severe sepsis are not documented to have this diagnosis by their physicians. 4 Therefore, work aimed at improving the recognition of patients with sepsis is critical to improving their short-and long-term outcomes. In this review, we discuss how the definition of sepsis has evolved over time and the ABBREVIATIONS: EHR = electronic health record; ICD-9 = International Classification of Diseases, Ninth Revision; NPV = negative predictive value; PPV = positive predictive value; qSOFA = quick sepsis-related organ failure assessment; SIRS = systemic inflammatory response syndrome; SSC = Surviving Sepsis Campaign
More recently, Bhattacharjee et al. REF conducted a review to analyze recent advancements in the area of sepsis detection on the hospital wards.
Identifying Patients With Sepsis on the Hospital Wards
Chest
Medicine