{"id":27415,"date":"2024-12-20T04:54:00","date_gmt":"2024-12-19T20:54:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27415"},"modified":"2024-12-20T05:43:45","modified_gmt":"2024-12-19T21:43:45","slug":"27415","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27415","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u533b\u9662\u666e\u901a\u75c5\u623f\u60a3\u8005\u7684\u7535\u5b50\u8113\u6bd2\u75c7\u9884\u8b66"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

December 10, 2024<\/p>\n\n\n\n

Electronic Sepsis Screening Among Patients Admitted to Hospital Wards: A Stepped-Wedge Cluster Randomized Trial<\/h1>\n\n\n\n

Yaseen M. Arabi, Abdulmohsen Alsaawi, Mohammed Alzahrani, et al<\/h3>\n\n\n\n

JAMA. <\/em>Published online December 10, 2024. doi:10.1001\/jama.2024.25982<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Does electronic sepsis screening based on quick Sequential Organ Failure Assessment score (qSOFA), compared with no screening, reduce the mortality of patients admitted to hospital wards?<\/p>\n\n\n\n

Findings<\/strong>  In a stepped-wedge, cluster randomized trial at 45 wards (clusters) in 5 hospitals in Saudi Arabia, 29\u202f442 patients were in the screening group and 30\u202f613 in the no screening group. Accounting for period, clustering within wards, hospitals, and COVID-19 status, electronic sepsis screening significantly reduced in-hospital mortality within 90 days compared with no screening (adjusted relative risk, 0.85).<\/p>\n\n\n\n

Meaning<\/strong>  In hospitalized ward patients, electronic sepsis screening compared with no screening resulted in reduced 90-day in-hospital mortality.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness.<\/p>\n\n\n\n

Objective<\/strong>  To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021.<\/p>\n\n\n\n

Intervention<\/strong>  An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile.<\/em><\/p>\n\n\n\n

Results<\/strong>  Among 60\u202f055 patients, 29\u202f442 were in the screening group and 30\u202f613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30\u202f596 were male (51.0%). Alerts occurred in 4299 of 29\u202f442 patients (14.6%) in the screening group and 5394 of 30\u202f613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P<\/em>\u2009<\u2009.001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile<\/em>.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04078594<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27415"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27415"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27415\/revisions"}],"predecessor-version":[{"id":27419,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27415\/revisions\/27419"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27415"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27415"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27415"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}