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 Journal Article


Authors: Rech, M. A.; Mosier, M. J.; Zelisko, S.; Netzer, G.; Kovacs, E. J.; Afshar, M.
Article Title: 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
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.
Keywords: Pulmonary and Critical Care Medicine
Journal Title: Journal of burn care research : official publication of the American Burn Association
ISSN: 1559-0488; 1559-047X
Publisher: Unknown  
Journal Place: United States
Date Published: 2017
Language: eng
DOI/URL:
Notes: LR: 20170225; GR: R01 AG018859/AG/NIA NIH HHS/United States; JID: 101262774; aheadofprint