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Volume 18 Supplement 2

Sepsis 2014

  • Poster presentation
  • Open Access

Evaluating the sensitivity and specificity of a severe sepsis tool utilized at a community hospital in Miami, FL

  • J Hirigoyen1
Critical Care201418(Suppl 2):P16

https://doi.org/10.1186/cc14019

Published: 3 December 2014

Keywords

Severe SepsisSeptic PatientCommunity HospitalRetrospective Chart ReviewReceiver Operating Curve

Introduction

Since the initial development of the Surviving Sepsis Campaign guidelines outlining the management of severe sepsis, there has been an absolute discount on the management of septic patients in medical surgical units. In efforts to improve severe sepsis, a community hospital in Miami adopted a severe sepsis screening tool (SSST) to rapidly identify severe septic patients in medical surgical units. A pilot study was conducted to evaluate the sensitivity and specificity of the SSST.

Methods

A descriptive retrospective study. There were two phases. Phase 1 evaluated the percentage of patients with sepsis criteria utilizing the SSST. Patients admitted to 4 Tower during 2013 presenting with a diagnosis of sepsis syndrome and admitted to 4 Tower presenting without sepsis syndrome were reviewed. Phase 2 evaluated the sensitivity and specificity of SSST from August 2013 to January 2014. Total number of patients admitted to 4 Tower: of those patients, total number with discharge diagnosis of sepsis, total number who screened positive >1 time during hospital stay, and total number who screened negative during hospital stay; there were five missing cases. The receiver operating curve (Figure 1) and the respective area under the curve were calculated. Utilizing a 2 × 2 design, the sensitivity and specificity of the tool was calculated.
Figure 1
Figure 1

ROC curve.

Results

Phase 1: a total of 220 patients records were reviewed, a frequency distribution was utilized (Table 1), demonstrating that the SSST identified those patients with sepsis criteria 76 % (n = 167) of the time. Phase 2: a total of 1,555 patients were included during phase 2. A 2 × 2 design (Table 2) was utilized: 78 patients were identified as true positive and 1,233 patients were identified as true negative. The study yielded a sensitivity of 41.49% and a specificity of 90.53%. The positive predictive value of the tool was estimated at 37.68%, negative predictive value was estimated at 91.81% and disease prevalence was 12.13%. Area under the receiver operating curve (Table 3) was 0.66.
Table 1

Frequency distribution.

Statistics

Diagnosis on admission

Sepsis tool identifies sepsis

  

Valid

220

220

  

Missing

0

0

  

Frequency table

Frequency

Percent

Valid percentage

Cumulative percentage

Diagnosis on admission

   

  Valid

220

100.0

100.0

100.0

Sepsis tool identifies sepsis

   

Not valid

53

24.1

24.1

24.1

  Valid

167

75.9

75.9

100.0

  Total

220

100.0

100.0

 
Table 2

The 2 × 2 design.

 

Sepsis present

Sepsis absent

Positive

78 true positive

129 false positive

Negative

110 false negative

1,233 true negative

Table 3

Area under the curve.

Test result variable(s):screen

Area

0.660

Conclusion

A two-phase retrospective chart review study demonstrated that the SSST utilized at a community hospital in Miami had a sensitivity value of 41.49% and a specificity value of 90.53% when evaluating medical surgical patients. These results indicate the tool is accurate in detecting patients that are not septic; however, it is not reliable in identifying patients who are truly septic. Further studies need to be conducted to validate the sensitivity and specificity of the SSST; changes will be recommended in an effort to improve sensitivity.

Declarations

Acknowledgements

Thanks to Eve Butler and Andrea Prentiss from Baptist Research Department, 4 Tower team. Special thanks to Melanie Santos, Luz Lorenzo, Disney Granado, Katiuska Diaz, Sandra Benitez, Magdely Perez, Viviana Castillo and Ofelia Cabrera.

Authors’ Affiliations

(1)
4 Tower Medical-Surgical Unit, Baptist Hospital of Miami, Miami, USA

Copyright

© Hirigoyen; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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