Comparison of Automated Methods Versus the American Burn Association Sepsis Definition to Identify Sepsis and Sepsis With Organ Dysfunction/Septic Shock in Burn-Injured Adults

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Abstract

To develop an algorithm to identify sepsis and sepsis with organ dysfunction/septic shock in burn-injured patients incorporating criteria from the American Burn Association sepsis definition that possesses good test characteristics compared with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9) codes and an algorithm previously validated in nonburn-injured septic patients (Martin et al method). This was a retrospective cohort study of consecutive patients admitted to the burn intensive care unit between January 2008 and March 2015. Of the 4761 admitted, 8.6% (n = 407) met inclusion criteria, of which the case rate for sepsis was 34.2% (n = 139; n = 48 sepsis; n = 91 sepsis with organ dysfunction/septic shock). For sepsis identification, the novel algorithm had an accuracy of 86.0% (95% CI: 82.2–89.2%), sensitivity of 66.9% (95% CI: 59.1–74.7%), and specificity of 95.9% (95% CI: 93.5–98.3%). The novel algorithm had better discrimination (0.81, 95% CI: 0.77–0.86) than the ICD-9 method (0.77, 95% CI: 0.73–0.81), although this was not significant (P = .08). For sepsis with organ dysfunction/septic shock, the novel algorithm plus vasopressors (0.67, 95% CI: 0.63–0.72) and the ICD-9 method (0.63, 95% CI: 0.58–0.68) performed equivocal (P = 0.15) but the Martin method (0.76, 95% CI: 0.71–0.81) had superior discrimination than other methods (P < .01). The novel algorithm is an accurate and simple tool to identify sepsis in the burn cohort with good sensitivity and specificity and equivocal discriminative ability to ICD-9 coding. The Martin method had superior discriminative ability for identifying sepsis with organ dysfunction/septic shock in burn-injured patients than either the novel algorithm plus vasopressors or ICD-9 coding.

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