Electronic Sepsis Screening Among Patients Admitted to Hospital Wards
Yaseen M. Arabi, Abdulmohsen Alsaawi, Mohammed Alzahrani, Ali M. Al Khathaami, Raed H. AlHazme, Abdullah Al Mutrafy, Ali Al Qarni, Ramesh Vishwakarma, Rasha Al Anazi, Eman Al Qasim, Sheryl Ann Abdukahil, Fawaz K. Al-Rabeah, Huda Al Ghamdi, Abdulaleem Alatassi, Hasan M. Al‐Dorzi, Fahad Al-Hameed, Razan Babakr, Abdulaziz Alghamdi, Salih Bin Salih, Ahmad Alharbi, Mufareh Alkatheri, Hani Mustafa, Saad Al-Qahtani, Shaher Qahtani, Nahar Alselaim, Nabiha Tashkandi, Ali Alyami, Zeyad Alyousef, Omar Aldibasi, Abdul Hadi Al-Qahtani, Abdulaziz Al‐Dawood, Angela Caswell, Nouf Al Ayadhi, Hadeel Al Rehaili, Ahmed Alarfaj, Hamdy Mubarak, Turki Alwasaidi, Saleh M Al Zahrani, Yousef Alalawi, Abdulrahman Alhadab, Tariq Nasser, Tagwa Omer, Sameera M. Al Johani, Abdulaziz Alajlan, Musharaf Sadat, Mohammed Alzunitan, Saad A. Al Mohrij, SCREEN Trial Group and the Saudi Critical Care Trials Group, Ebtisam Al Ghamdi, Haifa Al Shammari, Sarah Al Zighaibi, Fady Al Harbi, Mohammed Al Kanhel, Saad Al Nofaie, Mohamed Al Moammary, Soud Rasheed, Tariq Debasi, Khadega A. Abuelgasim, Faisal Thekair, Saleh Qasim, Saeed Obbed, Jamila Al Onazi, Majid M. Alshamrani, Abdul Rahman Jazieh, Ashwaq Al Olayan, Mohamed Al Harbi, Georges Nammour, J. Jones, Amal Matroud, Jacqueline Hendricks, Judelyn Jambalos, Pauline Mmaletshabo Maake, Florbela Maria Ribeiro, Arlene Panadero, Mohammed Al Qarni, Wasil Jastaniah, Arwa O. Yamani, Hassan Almarhabi, Omer Abuskout, Basem R. Banat, Eman Matar, Elizabeth Moodi, J Naidoo, Hala Ghamdi, Mayadah Habshi, Adnan A. Munshi, Alhafidz Hamdan, Talal Swilem, Jamal Chalabi, Michael Lorentziadis, Mohammed Shahin, Jamielah Yaakob, Johanna E. Greyvenstein, Sami Musalam Aliyyen, Christa Myumi Sian, Ahmad Salahaldeen, Shantal Pienaar, Sukaina Al Tuwal, Waleed K. Al-Arfaj, Abdulaziz Al Qasem
Abstract
Importance: Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness. Objective: To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients. Design, Setting, and Participants: In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021. Intervention: An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening. Main Outcomes and Measures: The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile. Results: Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile. Conclusions and Relevance: Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT04078594.