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. 2018 Jun 25;2018(6):CD012404. doi: 10.1002/14651858.CD012404.pub2

Hooper 2012.

Methods Study reported in full: single‐centre, parallel‐group RCT taking place between May and August 2009
Participants 442 participants under the care of the MICU were enrolled in the study
Patients were eligible to be included if they met modified SIRS criteria, defined as ≥ 2 of the 4 SIRS criteria within a rolling 24‐h window, with at least 1 being an abnormal temperature or white blood cell count.
SIRS criteria

  1. Temperature > 38 °C or < 36 °C

  2. Heart rate > 90 beats per minute

  3. Respiratory rate > 20 breaths per minute or PaCO₂ < 32 mmHg

  4. White blood cell count > 12000 cells mm³ or < 4000 cells mm³, or > 10% immature (band) forms


Patients were excluded from the study if they had been previously enrolled during the same hospital admission, or if they were being cared for in the MICU by a team other than one of the MICU teams.
Enrollment time was considered to be the first time a participant met modified SIRS criteria while under the care of the MICU.
Participants were followed up for 28 days
After discharge from hospital participants were eligible for re‐enrolment if they were subsequently readmitted.
Age in years: intervention = 55 (mean), 18 (SD); control = 54 (mean), 18 (SD)
Gender (male/female): intervention = 125:95; control = 118:104
Study took place in Vanderbilt University, USA
Interventions Computerized monitoring + notifications (n = 220): notifications that modified SIRS criteria had been met were sent via text message to the pagers of the primary team physician contact. A flag appeared against the participant's name on the physician's electronic patient list. Pages were sent to those who were listed as the current primary contact for the admitting team, but notifications in the medical record were available to all physicians taking care of the participant. Physicians were asked to acknowledge receipt of the notification and indicate if the participant had sepsis. if a physician failed to respond, a reminder was resent after 1 hour. System gave no management recommendations and providers were not instructed to treat alerted participants in a different manner than any other patient. If physicians determined participants to be septic, further system notifications suspended for 7 days. If physicians determined participant not to be septic, further notifications suspended for 2 days unless a previously normal white blood cell count or temperature became abnormal
Computerized monitoring + no notification control group (n = 222): participants received computerized monitoring that generated a time stamp when modified SIRS criteria were met. However notifications were not relayed to any physicians.
Outcomes

  1. Follow‐up to 28 days or hospital discharge, whichever occurred first

  2. Time to administration of first or changed antibiotic

  3. 6‐h fluid intake/output

  4. Daily fluid intake/output

  5. Lactate measurement

  6. Daily vasopressor administration

  7. Hypotensive at enrolment

  8. ICU length of stay

  9. Hospital length of stay

  10. Mortality

  11. Sepsis diagnosed
Notes We contacted study author by email to check relationship between this study and Hooper 2010, and Hooper 2011. Email bounced back and we could not find up‐to‐date contact information.
States that this study was grant supported by 1RC1LM010310‐01 from NIH, 1UL1 RR024975 from NCRR/NIH, and CCF0424422 from NSF
Declaration of interest: states that the study authors have not disclosed any potential conflicts of interest
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk States that participants were randomized, but methods for randomization not stated
Allocation concealment (selection bias) Unclear risk Not stated
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Not stated
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Not stated
Incomplete outcome data (attrition bias) 
 All outcomes Low risk 1 post‐randomization exclusion due to early death. No other apparent loss to follow‐up
Selective reporting (reporting bias) Unclear risk No other sources of bias identified
Other bias Low risk Not identified

ICU: intensive care unit
 MICU: medical intensive care unit
 RCT: randomized controlled trial
 SIRS: systemic inflammatory response syndrome