FACTORS ASSOCIATED WITH THE EARLY IDENTIFICATION OF SEPSIS

Abstract

The incidence of sepsis is increasing and is one of the most frequent causes of death in hospitals in the United States. Sepsis is a heterogeneous clinical syndrome that is difficult to identify in rapid clinical settings such as the emergency department (ED). The purpose of this study was to identify a model that will inform the development of a sepsis screening tool for early recognition of sepsis on arrival to the ED. A retrospective chart review, study sample was obtained from an administrative database. Study data were collected, and prepared, and descriptive and comparison analytics performed. Logistic regression was used for model building. Odds ratios were used to build a scoring tool which was tested for sensitivity and specificity. Most of the sample was White (76.5%), female (51.7%), and lived at home (81.3%). The mean age of sepsis was 64.95 years (SD = 18.73) and the mean age for severe sepsis/septic shock 68.3 years (SD = 14.32). Only 6.7% of individuals with sepsis died, and 25% of individuals with severe sepsis/septic shock died during their hospital stay. Variables were entered into the model in a stepwise process. The final model consisted of five variables: (a) systolic blood pressure [less-than or equal to] 100 mmHg (yes/no), (b) ages [greater-than or equal to] 54 or [less-than or equal to] 80 years (yes/no), (c) respiratory rate [greater-than or equal to] 22 breaths per minute (yes/no), (d) chief complaint of fever or chills (yes/no), and (e) altered mental status or Glasgow Coma Scale [less-than or equal to] 14 (yes/no). The model was statistically significant ( -2 Log Likelihood = 759.80, [chi]2(5) = 71.98, p <.000). A scoring tool was build and each individual in the initial study was scored using the scoring tool. A score [greater-than or equal to] 4 had a sensitivity level 68%, a specificity of 55%, and area under the receiver operating curve of 0.65. The new sepsis tool requires further investigation to improve sensitivity and specificity.