Sepsis remains a significant source of mortality among hospitalized patients. This study examines the usage of a vital sign-based screening protocol in identifying postoperative patients at risk for sepsis at an academic-affiliated medical center. We identified all general surgery inpatients undergoing abdominopelvic surgery from January to June 2014, and compared those with positive screening tests to a sample of screen-negative controls. Multivariate logistic regression was used to identify predictors of positive screening tests and progression to severe sepsis. In total, 478 patients underwent abdominopelvic operations, 59 had positive screening tests, 33 qualified for sepsis, and six progressed to severe sepsis. Predictors of a positive screening test were presence of cancer [odds ratio (OR) 30.7, 95% confidence interval (CI) 2.2–420], emergency operation (OR 6.5, 95% CI 1.7–24), longer operative time (OR 2.2/h, 95% CI 1.2–4.1), and presence of postoperative infection (OR 6.4, 95% CI 1.5–27). The screening protocol had sensitivity 100 per cent and specificity 88 per cent for severe sepsis. We identified no predictors of severe sepsis. In conclusion, vital sign-based screening provides value by drawing early attention to patients with potential to develop sepsis, but escalation of care for these patients should be based on clinical judgment.
Get full access to this article
View all access options for this article.
References
1.
MurphyS.L., XuJ., KochanekK.D.Deaths: final data for 2010. National Vital Statistics Reports, Vol 61, No 4.Hyattsville, MD: National Center for Health Statistics, 2013.
2.
HallM.J., LevantS., DeFrancesC.J.Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000–2010. NCHS Data Brief, No 118. Hyattsville, MD: National Center for Health Statistics, 2013.
3.
HallM.J., WilliamsS.N., DeFrancesC.J.Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief, No 62. Hyattsville, MD: National Center for Health Statistics, 2011.
4.
AngusD.C., Linde-ZwirbleW.T., LidickerJ.Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.Crit Care Med2001; 29: 1303–10.
5.
MooreL.J., MooreF.A., ToddS.R.Sepsis in general surgery: the 2005–2007 National Surgical Quality Improvement Program perspective.Arch Surg2010; 145(7): 695–700.
6.
RiversE., NguyenB., HavstadS.Early goal-directed therapy in the treatment of severe sepsis and septic shock.N Engl J Med2001; 345: 1368–77.
7.
NguyenH.B., CorbettS.W., SteeleR.Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality.Crit Care Med2007; 35: 1105–12.
8.
NobreV., SarasinF.P., PuginJ.Prompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shock.Curr Opin Crit Care2007; 13: 586–91.
9.
The ProCESS Investigators, Yealy DM, Kellum JA, et al.A randomized trial of protocol-based care for early septic shock.N Engl J Med2014; 370: 1683–93.
10.
HooperM.H., WeavindL., WheelerA.P.Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit.Crit Care Med2012; 40: 2096–101.
11.
MooreL.J., JonesS.L., KreinerL.A.Validation of a screening tool for the early identification of sepsis.J Trauma2009; 66(6): 1539–46; discussion 1546–37.
