Table 3.
Top 10 items for each of 42 statistically generated treatment topics from an unsupervised machine learning approach using EHR data drawn from the first 24 hours of sepsis hospitalization. Item order is determined by item weighting from the treatment topic matrix produced using LDA. In some cases, item names have been shortened for visual clarity. Additional detail available within Supplementary Appendix Table 2. Headers represent summary clinical labels assigned following empiric algorithm topic determination as well as 11 larger categories in parentheses (italics).
| Acute coronary syndrome (Cardiovascular) | Atrial fibrillation (Cardiovascular) | Congestive heart failure (Cardiovascular) | Complex care (Complex) | End of life (Complex) | Failure to tdrive (Complex) |
|
| |||||
| Troponin I | Prothrombin time | CHF OS | Inpatient admission OS | Palliative care CS 1 | Tube feeding diet |
| ACS inpatient OS | Digoxin level | Troponin I | CBC with differential | Palliative care CS 2 | CBC with differential |
| Echocardiography | Anticoagulants coumarin | Loop diuretic | Palliative care CS 1 | Inpatient admission OS | Enteral alimentation OS |
| Electrocardiogram, 12 | Inpatient admission OS | B-type natriuretic peptide | Palliative care CS 2 | CBC with differential | Inpatient admission OS |
| Salicylate analgesics | Complete blood count | Electrocardiogram, 12 | Urinalysis without micro | Comfort care order set | Phenytoin level |
| Creatine kinase-MB | Digitalis glycosides | Inpatient admission OS | Lactic acid | IV Sodium chloride | NPO, tube feeding |
| Cardiology CS 2 | WBC differential, auto | Beta blockers | Admit to hospital | Narcotic agonists | Pneumonia OS |
| Cardiology CS 2 | Beta blockers | CBC with differential | Hospitalist initial CS | Urinalysis without micro | Urinalysis without micro |
| B-type natriuretic peptide | Lactic acid | Class IV antiarrhythmic | Blood culture | Admit to hospital | Nursing order |
|
| |||||
| Wound care (Complex) | Life support (Critical) | Mechanical ventilation (Critical) | Shock (Critical) | Critical illness (Critical) | Diabetes (Endocrine) |
|
| |||||
| Heparins | Blood culture | Prothrombin time | Urinalysis, micro only | ESBL Penicillin antibiotic | ESBL Penicillin antibiotic |
| Inpatient admission OS | Chest X-ray | Chest X-ray | Septic shock – EGDT | Mg replacement OS | Insulin sliding scale OS |
| Wound nurse CS | Arterial blood gas | Arterial blood gas | ICU admission OS 1 | K+ replacement OS | Inpatient admission OS |
| WBC differential, auto | CV sympathomimetics | Clinical restraints | Chest X-ray | Ionized calcium | CBC with differential |
| CBC with differential | Septic shock -- EGDT | Mechanical vent OS 2 | CV sympathomimetics | Phos replacement OS | Diabetes mellitus OS |
| Nursing wound care | ICU admission OS 1 | Ventilator therapy | Venous blood gas | Troponin I, POCT | Insulins - short acting |
| Glycopeptide antibiotics | Venous blood gas | Ventilation OS | Venous catheterization | Venous lactate, POCT | Urinalysis, without micro |
| Hospitalist CS 1 | ABO-Rh | Endotracheal tube | IV Sodium chloride | ICU admission OS 1 | Antipyretic non-narcotic |
| Urinalysis, micro | Clinical restraints | Anesthetic phenol | ICU admission OS 2 | Lactate, POCT | Lactic acid |
| Hospitalist CS 2 | Ventilator therapy | Benzodiazepines | CBC with differential | Critical care CS 2 | Admit to hospital |
| Urinalysis, without micro | Ventilation OS | ICU admission OS 1 | Manual differential | Critical care CS 1 | Blood culture |
|
| |||||
| Diabetic ketoacidosis (Endocrine) | Thyroid (Endocrine) | Hematologic panel (General) | Electrolyte panel (General) | Hepatic panel (General) | Severe illness (General) |
|
| |||||
| Insulin regular human | Serum albumin | Draw and hold plasma 1 | Serum magnesium | Serum AST | Troponin I, POCT |
| Ketone bodies | TSH level | Draw and hold serum | Phosphorus | Serum ALT | Lactate, POCT |
| DKA OS | Prealbumin | Draw and hold EDTA | Serum calcium | Alkaline phosphatase | Venous lactate, POCT |
| Insulins - short acting | Serum magnesium | Draw and hold serum | Chemistry panel 7 | Total bilirubin | Inpatient admission OS |
| Blood glucose, POCT | Serum calcium | Draw and hold plasma 2 | CBC with differential 2 | Serum magnesium | Venous blood gas |
| Insulin sliding scale OS | Phosphorus | Draw and hold heparin | WBC differential, auto | Serum calcium | Electrocardiogram, 12 |
| ICU admission OS 1 | Chemistry panel 7 | CBC with differential | Lactic acid | Phosphorus | WBC differential, auto |
| Intensive insulin OS | WBC differential, auto | Inpatient admission OS | CBC with differential | Chemistry panel 7 | CBC with differential |
| Chemistry panel 7 | Incentive spirometry | Manual differential | Serum albumin | Lipase | Admit to hospital |
| Ketone, serum | Inpatient dietary CS | Blood culture 2 | Serum potassium | CBC with differential | Pneumonia OS |
|
| |||||
| Abdominal pain (Gastrointestinal) | Biliary disease (Gastrointestinal) | Diarrhea (Gastrointestinal) | Liver disease (Gastrointestinal) | Gastrointestinal bleeding (Gastrointestinal) | Hepatitis (Gastrointestinal) |
|
| |||||
| CT abdomen/pelvis | Serum ALT | Clostridium difficile panel | Ammonia | ABO-Rh | Hepatitis C antibody |
| Narcotic agonists | Serum AST | Contact plus isolation | Ultrasound abdomen | Transfusion OS | Hepatitis B surface Ag |
| Gastroenterology CS 1 | Alkaline phosphatase | Stool culture | Acute renal failure OS | Antibody screen | Hepatitis B surface Ab |
| Gastroenterology CS 2 | Total bilirubin | Stool WBC | WBC differential, auto | Hemoglobin/hematocrit | Hepatitis B core antibody |
| Inpatient admission OS | Lipase | Metronidazole | Laxatives | Type and crossmatch | Hepatitis A virus IgM |
| CBC with differential | Chemistry panel 7 | Clostridium difficile toxin | Services after hours | Type and screen | HIV 1/2 antibody |
| General surgery CS 2 | CBC with differential | Inpatient admission OS | CBC with differential | Crossmatch, immediate | Ultrasound abdomen |
| General surgery CS 1 | Lactic acid | CBC with differential | Sepsis ED OS | Crossmatch, electronic | US abdomen, B-scan |
| Metronidazole | WBC differential, auto | Protozoa smear | Draw and hold pink top | Prothrombin time | Antinuclear antibody |
| Serotonin antagonist | Serum amylase | WBC differential, auto | CT, 3D rendering | GI bleed OS | Acetaminophen level |
|
| |||||
| Surgery (Gastrointestinal) | Anemia (Hematologic) | Cytopenia (Hematologic) | Coagulopatdy (Hematologic) | Cellulitis (Musculoskeletal) | Indolent infection (Musculoskeletal) |
|
| |||||
| General surgery CS 1 | Iron and TIBC | Transfusion OS | Lactate dehydrogenase | US Venous Doppler | ESR |
| General surgery CS 2 | Ferritin | ABO-Rh | Fibrinogen activity | Cellulitis OS | C-reactive protein |
| Surgery admission OS | Vitamin B12 | Antibody screen | APTT | Inpatient admission OS | Infectious disease CS 1 |
| Surgery/intra-op OS | Folic acid, serum | Neutropenic fever OS | Fibrinogen degradation | Vancomycin level, trough | Infectious disease CS 2 |
| Narcotic agonists | Reticulocyte count | WBC differential, manual | Serum ALT | CBC with differential | Orthopedics CS 2 |
| PACU/anesthesia OS | Transferrin | CBC with differential | D-dimer | Glycopeptide antibiotics | Orthopedics CS 1 |
| Transfer level of care | Occult blood specimen | Antipyretic non-narcotic | Serum AST | WBC differential, auto | Narcotic agonists |
| CT abdomen/pelvis | Protein electrophoresis | Heme-Onc CS 1 | Total bilirubin | Narcotic agonists | Vancomycin level, trough |
| Anesthetic – narcotic | TSH | Inpatient admission OS | Alkaline phosphatase | US duplex scan | Glycopeptide antibiotics |
| Anaerobic culture | Head and neck CS 1 | Heme-Onc CS 2 | Prothrombin time | Lactic acid | CBC with differential |
|
| |||||
| Osteomyelitis (Musculoskeletal) | Weakness (Neurologic) | Confusion (Neurologic) | Acute kidney injury (Renal) | Dialysis (Renal) | Pyelonephritis (Renal) |
|
| |||||
| Podiatry CS 1 | CT head, no contrast | Drug screen, urine | Sodium, urine | Hemodialysis OS | Urology CS 1 |
| Podiatry CS 2 | CT head | CT head, no contrast | Creatinine, urine | Nephrology CS 2 | Urology CS 2 |
| Radiologic exam, foot | Inpatient admission OS | CT head | Osmolality, urine | Nephrology CS 1 | Urine culture |
| Culture, miscellaneous | WBC differential, auto | Alcohol withdrawal OS | Osmolality, serum | Phosphate binders | CBC with differential |
| Gram stain | CBC with differential | Alcohol level | Sodium, serum | Vancomycin level | Gentamicin level |
| Insulin sliding scale OS | Creatine kinase | MRI brain | Ultrasound abdomen | Calcineurin inhibitors | CT abdomen/pelvis |
| Anaerobic culture | Physical therapy | Lumbar puncture OS | Eosinophils, urine | Insulin sliding scale OS | IV Gentamicin |
| Vancomycin level, trough | Urinalysis, without micro | Neurology CS 1 | Chemistry panel 7 | Diet, renal | Lactic acid |
| Glycopeptide antibiotics | Troponin I | Neurology CS 2 | Acute renal failure OS | Mycophenolate | Narcotic agonists |
|
| |||||
| Urinary tract infection (Renal) | Atypical pneumonia (Respiratory) | COPD/Astdma (Respiratory) | Non-invasive ventilation (Respiratory) | Pneumonia (Respiratory) | Viral pneumonia (Respiratory) |
|
| |||||
| Inpatient admission OS | AFB culture and smear | Pneumonia OS | BIPAP ventilation | Pneumonia OS | Pneumonia OS |
| CBC with differential | Pneumonia OS | Glucocorticoids | Arterial blood gas | Inpatient admission OS | Droplet isolation |
| Narcotic agonists | CT chest | COPD/asthma OS | Pneumonia OS | CBC with differential | Inpatient admission OS |
| WBC differential, auto | L. pneumophila Ag | Inpatient admission OS | Non-invasive ventilation | WBC differential, auto | CBC with differential |
| Antipyretic non-narcotic | M. pneumoniae IgM | Respiratory culture | Glucocorticoids | Glucocorticoids | Flu A/B, RSV PCR |
| Lactic acid | Respiratory culture | Respiratory gram stain | B-type natriuretic peptide | COPD/asthma OS | WBC differential, auto |
| Urinalysis, without micro | Respiratory gram stain | CBC with differential | ICU admission OS | Admit to hospital | Antipyretic non-narcotic |
| Serotonin antagonists | Pulmonary initial CS | Lactic acid | Chest X-ray | Blood culture | 3rd gen Cephalosporin |
| IV Sodium chloride | Head and neck CS 1 | Heme-Onc CS 2 | Prothrombin time | Blood culture 2 | Neuraminidase inhibitors |
ACS, acute coronary syndrome; CBC, complete blood count; CS, consult; CHF, congestive heart failure; CV, cardiovascular; CT, computed tomography; DKA, diabetic ketoacidosis; EGDT, early goal directed therapy; ESBL, extended-spectrum beta-lactamase; ICU, intensive care unit; IV, intravenous; K+, potassium; Mg, Magnesium; NPO, nil per os; Phos, phosphorus; POCT, point of care testing; US, ultrasound; WBC, white blood cell.