Prospective validation of a near real-time EHR-integrated automated SOFA score calculator
Prospective validation of a near real-time EHR-integrated automated SOFA score calculator
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DOI：
10.1016/j.ijmedinf.2017.04.001
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发表时间：
2017-07-01
影响因子：
4.9
通讯作者：
Herasevich, Vitaly
中科院分区：
文献类型：
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作者：
Aakre, Christopher;Franco, Pablo Moreno;Herasevich, Vitaly
目标：我们创建了一种在电子健康记录 (EHR) 中自动计算序贯器官衰竭评估 (SOFA) 评分的算法，以促进基于脓毒症和脓毒性休克第三次国际共识定义 (SEPSIS-3) 临床定义的脓毒症检测。我们评估了近实时和日常自动化 SOFA 评分计算与手动评分计算的准确性。方法：使用可用的 EHR 数据源开发了自动 SOFA 评分计算机程序，并将其集成到明尼苏达州罗切斯特市 Mayo Clinic 的以重症监护为重点的患者护理仪表板中。我们前瞻性地比较了明尼苏达州罗彻斯特和佛罗里达州杰克逊维尔梅奥诊所医院重症监护室收治的患者样本的自动计算与手动计算的准确性。一致性是用 Cohen 的 kappa 统计量计算的。在人工审核期间将差异原因制成表格。 结果：对 27 名独特患者进行了 134 次随机抽查比较，并在总共 1206 个患者日内对 215 名患者进行了每日 SOFA 评分比较。随机抽查（696 对，= 0.89）和每日计算（5972 对，kappa = 0.89）的自动评分和手动评分 SOFA 组件之间的一致性很高。最常见的差异在于呼吸成分（吸入氧回收的不准确分数；200/1206）和肌酐（透析无尿量患者肌酐正常；128/1094）。 147 名患者在进入重症监护病房后有患败血症的风险，其中 10 名患者后来经图表审查确认患上败血症。所有患者均在脓毒症发作前按照 Delta SOFA >= 2 分标准进行识别，其中 46 名患者为假阳性。结论：近实时自动 SOFA 评分与手动评分计算高度一致，可能有助于利用新的 SEPSIS-3 定义检测脓毒症。
Objectives: We created an algorithm for automated Sequential Organ Failure Assessment (SOFA) score calculation within the Electronic Health Record (EHR) to facilitate detection of sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) clinical definition. We evaluated the accuracy of near real-time and daily automated SOFA score calculation compared with manual score calculation.Methods: Automated SOFA scoring computer programs were developed using available EHR data sources and integrated into a critical care focused patient care dashboard at Mayo Clinic in Rochester, Minnesota. We prospectively compared the accuracy of automated versus manual calculation for a sample of patients admitted to the medical intensive care unit at Mayo Clinic Hospitals in Rochester, Minnesota and Jacksonville, Florida. Agreement was calculated with Cohen's kappa statistic. Reason for discrepancy was tabulated during manual review.Results: Random spot check comparisons were performed 134 times on 27 unique patients, and daily SOFA score comparisons were performed for 215 patients over a total of 1206 patient days. Agreement between automatically scored and manually scored SOFA components for both random spot checks (696 pairs,. = 0.89) and daily calculation (5972 pairs, kappa = 0.89) was high. The most common discrepancies were in the respiratory component (inaccurate fraction of inspired oxygen retrieval; 200/1206) and creatinine (normal creatinine in patients with no urine output on dialysis; 128/1094). 147 patients were at risk of developing sepsis after intensive care unit admission, 10 later developed sepsis confirmed by chart review. All were identified before onset of sepsis with the Delta SOFA >= 2 point criterion and 46 patients were false-positives.Conclusions: Near real-time automated SOFA scoring was found to have strong agreement with manual score calculation and may be useful for the detection of sepsis utilizing the new SEPSIS-3 definition.