Electronic Alerts Help Reduce Missed Sepsis Diagnosis in Children

Using this method to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76%. 

It’s long been said that health IT should enhance, but never replace, traditional medicine, and a method of identifying sepsis in children that combines electronic alerts with physician judgement is an example of that idea. 

Researchers found that using this method to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76%. The study, along with an accompanying editorial, were published online in Annals of Emergency Medicine.

“Sepsis is a killer and notoriously difficult to identify accurately in children, which is why this alert is so promising,” lead study author Fran Balamuth, MD, PhD, MSCE, of Children’s Hospital of Philadelphia, in Philadelphia, Pa, said in a statement.

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“Identifying the rare child with severe sepsis or septic shock among the many non-septic children with fever and tachycardia in a pediatric ER is truly akin to finding the proverbial ‘needle in a haystack.’ This alert, especially with the inclusion of physician judgment, gets us much closer to catching most of those very sick children and treating them quickly.” 

Researchers built a two-stage alert (ESA) and implemented it into the hospital’s EHR. The first-stage alert is triggered when an age-based elevated heart rate or hypotensive blood pressure is documented in the EHR at any time during the emergency visit.

If the patient also has a fever or infection risk, the alert triggers a series of questions about underlying high-risk conditions, perfusion, and mental status. If the answer is yes to any of these questions, a second-stage alert triggers.

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Positive first- and second- stage alerts then trigger a “sepsis huddle:” A brief, focused patient evaluation and discussion with the treatment team, including the emergency physician.
 
“Clinical identification remains critically important to making this protocol successful in identifying and treating these sick children,” said Balamuth.
 
Of the 1.2% of the patients with positive ESAs, 23.8% had positive huddles and were placed on the sepsis protocol. The protocol missed 4% of patients who later went on to develop severe sepsis, which researchers attribute to “patient complexity,” especially among patients with developmental delays.
 
In accompanying editorial, Andrea Cruz, MD, MPH of the Baylor College of Medicine in Houston, writes, “This ESA advances the field of sepsis recognition by integrating vital sign anomalies, comorbidities that increase a child’s risk for sepsis, and clinical judgment into a tool that is both more sensitive and specific than prior alerts as well as less prone to alert fatigue.”