Table 3. Diagnostic Accuracy of Automated Electronic Sepsis Alerts.
| Source | Setting | Alert threshold | Prevalence, % | Sensitivity, % (95% CI) | Specificity, % (95% CI) | PPV, % (95% CI) | NPV, % (95% CI) | LR+, (95% CI) | LR-, (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
| Hooper et al.,10 2012 | MICU | ≥ 2 SIRS criteriaa | 36.3 | 98.9 (95.7-99.8) | 18.1 (14.2-22.9) | 40.7 (36.1-45.5) | 96.7 (87.5-99.4) | 1.21 (1.14-1.27) | 0.06 (0.01-0.25) |
| Meurer et al.,13 2009 | ED | ≥ 2 SIRS criteria | 27.8 | 36.2 (25.3-48.8) | 79.9 (73.1-85.3) | 41.0 (28.8-54.3) | 76.5 (69.6-82.2) | 1.80 (1.17-2.76) | 0.80 (0.67-0.96) |
| Nelson et al.,14 2011 | ED | ≥ 2 SIRS criteria and 2 SBP measurements < 90 mm Hg | 0.8 | 63.6 (31.6-87.8) | 99.6 (99.0-99.8) | 53.8 (26.1-79.6) | 99.7 (99.2-99.9) | 145.8 (58.4-364.1) | 0.37 (0.17-0.80) |
| Nguyen et al.,15 2014 | ED | ≥ 2 SIRS criteria and 1 sign of shock (SBP≤90 mm Hg or lactic acid ≥ 2.0 mmol/L) | Unable to estimate b | Unable to estimate b | Unable to estimate b | 44.7 (41.2-48.2) | 100.0 c (98.8-100.0) | Unable to estimate b | Unable to estimate b |
| Thiel et al.,16 2010 | Wards | Recursive partitioning tree analysis including vitals and laboratory resultsd | 4.7 | 17.1 (15.1-19.3) | 96.7 (96.5-96.9) | 20.5 (18.2-23.0) | 95.9 (95.7-96.2) | 5.22 (4.56-5.98) | 0.86 (0.84-0.88) |
Abbreviations: MICU, medical intensive care unit; SIRS, systemic inflammatory response syndrome; ED, emergency department; SBP, systolic blood pressure
a
Recorded within 24 hour period, mandating either abnormal temperature or WBC
b
False negative and true negatives unknown due to random sampling of non-alert cases
c
Estimated value based on random sample of 300 non-alert cases
d
Included shock index, mean arterial pressure, international normalized ratio, white blood cell count, absolute neutrophil count, bilirubin, albumin, hemoglobin, and sodium