Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) developed the targeted real-time early warning score (TREWScore) for the detection of potential future septic shock based on the electronic health record (EHR) of 16,234 patients admitted to the intensive care units (ICUs) at Beth Israel Deaconess Medical Center (BIDMC; Boston, MA, USA) between 2001 and 2007. The algorithm combines 27 different factors into a TREWScore that measures the risk of septic shock.

 

The TREWScore identifies patients whose data places them within an area under the receiver operating characteristic curve (AUC) of 0.83. Within that parameter, TREWScore showed specificity of 0.67 and sensitivity of 0.85, identifying patients at a median of 28.2 hours before onset, with two-thirds identified before any sepsis-related organ dysfunction. Accordingly, continuous sampling of data from the EHR and calculation of TREWScore may allow clinicians to identify patients at risk and provide earlier interventions. The study was published on August 5, 2105, in Science Translational Medicine.

 

“We know a lot of those deaths would likely be preventable if sepsis were diagnosed well before it develops into septic shock and organ failure,” said study coauthor Peter Pronovost, MD, PhD, vice president for patient safety and quality at JHU Medicine. “Right now, much of sepsis is invisible until someone is on death's door. Every passing hour before sepsis patients receive antibiotics correlates strongly with risk of death.”

 

“The algorithm could be programmed into an electronic health records system to alert doctors and nurses about a patient at risk of septic shock,” added study coauthor David Hager, director of the medical progressive care unit at the JHU Hospital. “The tricky issue is thinking about how the clinical team is provided with the information. A hospital's electronic health records system could be set up to convey alerts to clinicians via pager or cell phone at regular intervals.”

 

Severe sepsis or septic shock is a systemic inflammatory response syndrome secondary to a documented infection, with some evidence of organ dysfunction. It is manifested as a state of acute circulatory failure characterized by persistent arterial hypotension (despite adequate fluid management), or by tissue hypoperfusion unexplained by other causes.