Sepsis is a poorly understood and potentially life-threatening complication that can occur as a result of infection. Early detection and treatment improves patient outcomes, and as such it poses an important challenge in medicine. In this work, we develop a flexible classifier that leverages streaming lab results, vitals, and medications to predict sepsis before it occurs. We model patient clinical time series with multi-output Gaussian processes, maintaining uncertainty about the physiological state of a patient while also imputing missing values. The mean function takes into account the effects of medications administered on the trajectories of the physiological variables. Latent function values from the Gaussian process are then fed into a deep recurrent neural network to classify patient encounters as septic or not, and the overall model is trained end-to-end using back-propagation. We train and validate our model on a large dataset of 18 months of heterogeneous inpatient stays from the Duke University Health System, and develop a new "real-time" validation scheme for simulating the performance of our model as it will actually be used. Our proposed method substantially outperforms clinical baselines, and improves on a previous related model for detecting sepsis. Our model's predictions will be displayed in a real-time analytics dashboard to be used by a sepsis rapid response team to help detect and improve treatment of sepsis.
There are many previously published early warning scores for predicting clinical deterioration or other related outcomes. For instance, the NEWS score ( @cite_13 ) and MEWS score ( @cite_25 ) are two of the more common scores used to assess overall deterioration. The SIRS score for systemic inflammatory response syndrome was commonly used to screen for sepsis in the past ( @cite_10 ), although it has been phased out by other scores designed for sepsis such as SOFA ( @cite_26 ) and qSOFA ( @cite_6 ) in recent years.
@cite_13 @cite_26 @cite_6 @cite_10 @cite_25
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Abstract Introduction Early warning scores (EWS) are recommended as part of the early recognition and response to patient deterioration. The Royal College of Physicians recommends the use of a National Early Warning Score (NEWS) for the routine clinical assessment of all adult patients. Methods We tested the ability of NEWS to discriminate patients at risk of cardiac arrest, unanticipated intensive care unit (ICU) admission or death within 24h of a NEWS value and compared its performance to that of 33 other EWSs currently in use, using the area under the receiver-operating characteristic (AUROC) curve and a large vital signs database ( n =198,755 observation sets) collected from 35,585 consecutive, completed acute medical admissions. Results The AUROCs (95 CI) for NEWS for cardiac arrest, unanticipated ICU admission, death, and any of the outcomes, all within 24h, were 0.722 (0.685–0.759), 0.857 (0.847–0.868), 0.894 (0.887–0.902), and 0.873 (0.866–0.879), respectively. Similarly, the ranges of AUROCs (95 CI) for the other 33 EWSs were 0.611 (0.568–0.654) to 0.710 (0.675–0.745) (cardiac arrest); 0.570 (0.553–0.568) to 0.827 (0.814–0.840) (unanticipated ICU admission); 0.813 (0.802–0.824) to 0.858 (0.849–0.867) (death); and 0.736 (0.727–0.745) to 0.834 (0.826–0.842) (any outcome). Conclusions NEWS has a greater ability to discriminate patients at risk of the combined outcome of cardiac arrest, unanticipated ICU admission or death within 24h of a NEWS value than 33 other EWSs. Objective:To determine the prevalence and impact on mortality of delays in initiation of effective antimicrobial therapy from initial onset of recurrent persistent hypotension of septic shock.Design:A retrospective cohort study performed between July 1989 and June 2004.Setting:Fourteen intensive car An American College of Chest Physicians Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic parameters by which a patient may be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods when dealing with septic patients was recommended as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae. INTRODUCTIONThe Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODSA total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTSFifty-seven (17 ) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5 of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75 sensitive and 83 specific for patients who required transfer to ITU or HDU. CONCLUSIONSThe MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.