Sirs and Septic Shock Alert Evaluation

ABSTRACT

INTRODUCTION: Prompt recognition of sepsis is imperative for timely treatment and has led to the creation of the CERNER St. Johns Sepsis (SJS) Surveillance Agent Algorithm. Patient specific values are analyzed to determine if criteria for a Systemic Inflammatory Response Syndrome (SIRS) or Septic Shock Alert is met. The SJS Surveillance Agent Algorithm has a positive predictive value of 64%. The study site modified the alert criteria in the acute care areas and the emergency department to reduce alert fatigue. The purpose of this evaluation was to assess whether the modified alert criteria accurately identifies patients with possible sepsis. METHOD(S) This is a single center, retrospective, cohort evaluation. A Cerner Sepsis Audit report of all SIRS and Septic Shock Alert patients admitted between July 1 and July 14, 2021 was used for analysis. Patients were screened at random and included once per admission, first occurrence only. Patients were excluded if they had a presumed or confirmed COVID-19 diagnosis during admission. The proportion of SIRS and Septic Shock Alerts that correlate to a sepsis diagnosis and the proportion of patients with a discharge diagnosis code of sepsis where no alert was generated were analyzed using descriptive statistics. RESULT(S) A total of 147 patients were screened for inclusion with 121 patients included in the final analysis. There were 105 patients who triggered a SIRS or Septic Shock Alert and 16 patients coded for sepsis with no alert generated. The modified SJS criteria resulted in a positive predictive value of 60% (63 sepsis diagnosis vs. 42 noninfectious diagnosis). A majority of alerts were generated by SIRS criteria versus Septic Shock criteria. The most common non-infectious diagnoses in patients who alerted without sepsis were hemorrhage, hypovolemia, and trauma. CONCLUSION(S) Modification of the SJS algorithm occurred in an effort to decrease alert fatigue and was found to be comparable in positive predictive value to the unmodified algorithm.