Real-time identification of serious infection in geriatric patients using clinical information system surveillance
OBJECTIVES: To develop and characterize an automated syndromic surveillance mechanism for early identification of older emergency department (ED) patients with possible life-threatening infection.
DESIGN: Prospective, consecutive-enrollment, single-site observational study.
SETTING: A large university medical center with an annual ED census of 75,273.
PARTICIPANTS: Patients aged 70 and older admitted to the ED and having two or more systemic inflammatory response syndrome (SIRS) criteria during their ED stay.
MEASUREMENTS: A search algorithm was developed to screen the census of the ED through its clinical information system. A study coordinator confirmed all patients electronically identified as having a probable infectious explanation for their visit.
RESULTS: Infection accounted for 28% of ED and 34% of final hospital diagnoses. Identification using the software tool alone carried a 1.63 relative risk of infection (95% confidence interval CI51.09-2.44) compared with other ED patients sufficiently ill to require admission. Follow-up confirmation by a study coordinator increased the risk to 3.06 (95% CI52.11-4.44). The sensitivity of the strategy overall wasmodest (14%), but patients identified were likely to have an infectious diagnosis (specificity 598%). The most common SIRS criterion triggering the electronic notification was the combination of tachycardia and tachypnea.
CONCLUSION: A simple clinical informatics algorithm can detect infection in elderly patients in real time with high specificity. The utility of this tool for research and clinical care may be substantial.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2009 |
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| Erschienen: |
2009 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
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| Enthalten in: |
Journal of the American Geriatrics Society - 57(2009), 1 vom: 15. Jan., Seite 40-5 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Meurer, William J [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 06.03.2009 Date Revised 10.12.2019 published: Print Citation Status MEDLINE |
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| doi: |
10.1111/j.1532-5415.2008.02094.x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM186000677 |
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| 100 | 1 | |a Meurer, William J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Real-time identification of serious infection in geriatric patients using clinical information system surveillance |
| 264 | 1 | |c 2009 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 06.03.2009 | ||
| 500 | |a Date Revised 10.12.2019 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: To develop and characterize an automated syndromic surveillance mechanism for early identification of older emergency department (ED) patients with possible life-threatening infection | ||
| 520 | |a DESIGN: Prospective, consecutive-enrollment, single-site observational study | ||
| 520 | |a SETTING: A large university medical center with an annual ED census of 75,273 | ||
| 520 | |a PARTICIPANTS: Patients aged 70 and older admitted to the ED and having two or more systemic inflammatory response syndrome (SIRS) criteria during their ED stay | ||
| 520 | |a MEASUREMENTS: A search algorithm was developed to screen the census of the ED through its clinical information system. A study coordinator confirmed all patients electronically identified as having a probable infectious explanation for their visit | ||
| 520 | |a RESULTS: Infection accounted for 28% of ED and 34% of final hospital diagnoses. Identification using the software tool alone carried a 1.63 relative risk of infection (95% confidence interval CI51.09-2.44) compared with other ED patients sufficiently ill to require admission. Follow-up confirmation by a study coordinator increased the risk to 3.06 (95% CI52.11-4.44). The sensitivity of the strategy overall wasmodest (14%), but patients identified were likely to have an infectious diagnosis (specificity 598%). The most common SIRS criterion triggering the electronic notification was the combination of tachycardia and tachypnea | ||
| 520 | |a CONCLUSION: A simple clinical informatics algorithm can detect infection in elderly patients in real time with high specificity. The utility of this tool for research and clinical care may be substantial | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Smith, Barbara L |e verfasserin |4 aut | |
| 700 | 1 | |a Losman, Eve D |e verfasserin |4 aut | |
| 700 | 1 | |a Sherman, Diana |e verfasserin |4 aut | |
| 700 | 1 | |a Yaksich, Joseph D |e verfasserin |4 aut | |
| 700 | 1 | |a Jared, Jeremy D |e verfasserin |4 aut | |
| 700 | 1 | |a Malani, Preeti N |e verfasserin |4 aut | |
| 700 | 1 | |a Younger, John G |e verfasserin |4 aut | |
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