Digital Alerting and Outcomes in Patients With Sepsis: Systematic Review and Meta-Analysis

Joshi, Meera; Ashrafian, Hutan; Arora, Sonal; Khan, Sadia; Cooke, Graham; Darzi, Ara

doi:10.2196/15166

Cited by 48 publications

(43 citation statements)

References 42 publications

(153 reference statements)

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“…Hospital length of stay was found to be reduced with digital alerting. This is likely a result of earlier recognition of deterioration resulting in prompt clinical review and treatment administration; a recent systematic review concluded that digital alerts similarly reduced hospital length of stay in sepsis by 1.3 days 43 . This review adds further support to the literature demonstrating the benefit of digital alerting in remote settings across medical and surgical cohorts.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis

et al. 2021

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Advances in digital technologies have allowed remote monitoring and digital alerting systems to gain popularity. Despite this, limited evidence exists to substantiate claims that digital alerting can improve clinical outcomes. The aim of this study was to appraise the evidence on the clinical outcomes of digital alerting systems in remote monitoring through a systematic review and meta-analysis. A systematic literature search, with no language restrictions, was performed to identify studies evaluating healthcare outcomes of digital sensor alerting systems used in remote monitoring across all (medical and surgical) cohorts. The primary outcome was hospitalisation; secondary outcomes included hospital length of stay (LOS), mortality, emergency department and outpatient visits. Standard, pooled hazard ratio and proportion of means meta-analyses were performed. A total of 33 studies met the eligibility criteria; of which, 23 allowed for a meta-analysis. A 9.6% mean decrease in hospitalisation favouring digital alerting systems from a pooled random effects analysis was noted. However, pooled weighted mean differences and hazard ratios did not reproduce this finding. Digital alerting reduced hospital LOS by a mean difference of 1.043 days. A 3% mean decrease in all-cause mortality from digital alerting systems was noted. There was no benefit of digital alerting with respect to emergency department or outpatient visits. Digital alerts can considerably reduce hospitalisation and length of stay for certain cohorts in remote monitoring. Further research is required to confirm these findings and trial different alerting protocols to understand optimal alerting to guide future widespread implementation.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis

et al. 2021

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“…Sepsis is one of the main reasons for ICU admissions, and 6%-30% of all ICU patients are assumed to suffer from sepsis [ 44 ]. The disease is associated with a high mortality and a considerable cost burden [ 45 - 47 ]. The adequate initial volume application is essential in the initial resuscitation of sepsis [ 8 - 11 ], and it affects patients’ outcome and mortality risk [ 4 - 6 ].…”

Section: Discussionmentioning

confidence: 99%

Fluid Administration in Emergency Room Limited by Lung Ultrasound in Patients with Sepsis: Protocol for a Prospective Phase II Multicenter Randomized Controlled Trial

Mohamed¹,

Malewicz²,

Zehry³

et al. 2020

JMIR Res Protoc

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Background Sepsis remains a major health challenge with high mortality. Adequate volume administration is fundamental for a successful outcome. However, individual fluid needs differ between patients due to varying degrees of systemic vasodilation, circulatory flow maldistribution, and increased vascular permeability. The current fluid resuscitation practice has been questioned. Fluid overload is associated with higher mortality in sepsis. A sign of fluid overload is extravascular lung water, seen as B lines in lung ultrasound. B lines correlate inversely with oxygenation (measured by a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen ie, PaO2/FiO2). Thus, B lines seen by bedside ultrasound may have a role in guiding fluid therapy. Objective We aim to evaluate if fluid administration guided by lung ultrasound in patients with sepsis in emergency departments will lead to better oxygenation and patient outcomes than those in the standard therapy. Methods A phase II, multicenter, randomized, open-label, parallel-group, superiority trial will be performed. Patients will be recruited at emergency departments of the participating centers. A total of 340 patients will be randomly allocated to the intervention or standard-of-care group (30mL/kg). The intervention group will receive ultrasound-guided intravenous fluid until 3 B lines appear. The primary outcome will be oxygenation (measured as PaO2/FiO2 ratio) at 48 hours after starting intravenous fluid administration. Secondary outcomes will be patients’ outcome parameters, including oxygenation after 15 mL/kg fluid at 6, 12, 24, and 48 hours; sepsis progress through Sequential Organ Failure Assessment (SOFA) scores; pulmonary edema evaluation; and 30-day mortality. Results The trial will be conducted in accordance with the Declaration of Helsinki. Institutional review board approval will be sought after the participating sites are selected. The protocol will be registered once the institutional review board approval is granted. The trial duration is expected to be 1.5-2.5 years. The study is planned to be performed from 2021 to 2022, with enrollment starting in 2021. First results are expected in 2022. Informed written consent will be obtained before the patient’s enrollment in the study. An interim analysis and data monitoring will ensure the patient safety. The results will be published in a peer-reviewed journal and discussed at international conferences. Conclusions This is a protocol for a randomized control trial that aims to evaluate the role of bedside ultrasound in guiding fluid therapy in patients with sepsis via B lines evaluation. International Registered Report Identifier (IRRID) PRR1-10.2196/15997

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“…MEDLINE and Embase were then used to pilot and refine the search strategy to ensure the final search would be as comprehensive as possible, without becoming too time-consuming and impractical. The search strategies of previous relevant systematic reviews were also retrieved and analyzed for additional relevant terms and text words [ 16 , 27 , 28 , 33 , 40 ]. An example of the final search strategy, used to search MEDLINE, is presented in Multimedia Appendix 1 .…”

Section: Methodsmentioning

confidence: 99%

“…EHR-based computerized clinical decision support (CCDS) systems, built into hospital electronic systems, present a great opportunity to facilitate sepsis early detection and prompt treatment. CCDS systems automate sepsis-risk warning tools to alert clinicians to the possible presence of sepsis [ 16 , 27 ], while reducing the mental load on clinicians and nurses [ 28 , 29 ]. Following an alert, a protocol is followed that usually involves a patient being evaluated by senior medical staff to confirm diagnosis and initiate the appropriate sepsis treatment [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Use and Evaluation of Computerized Clinical Decision Support Systems for Early Detection of Sepsis in Hospitals: Protocol for a Scoping Review

Li¹,

Ackermann²,

Baker³

et al. 2020

JMIR Res Protoc

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Background Sepsis is a leading cause of death in hospitals, with high associated costs for both patients and health care systems worldwide. Early detection followed by timely intervention is critical for successful sepsis management and, hence, can save lives. Health care institutions are increasingly leveraging clinical data captured in electronic health records for the development of computerized clinical decision support (CCDS) systems aimed at enhancing the early detection of sepsis. However, a comprehensive evidence base regarding sepsis CCDS systems to inform clinical practice, research, and policy is currently lacking. Objective This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for early detection of sepsis in hospitals. Methods The methodology for conducting scoping reviews presented by the Joanna Briggs Institute Reviewer’s Manual and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) will be used and adapted as guides. A comprehensive literature search of 10 electronic databases will be conducted to identify all empirical quantitative and qualitative studies that investigate the use of CCDS systems for early detection of sepsis in hospitals. Detailed inclusion and exclusion criteria have been developed. Two reviewers will independently screen all articles based on these criteria. Any discrepancies will be resolved through discussion and further review by a third researcher if required. Results Electronic database searches have retrieved 12,139 references after removing 10,051 duplicates. As of the submission date of this protocol, we have completed the title and abstract screening. A total of 372 references will be included for full-text screening. Only 15.9% (59/372) of these studies were focused on children: 11.0% (41/372) for pediatric and 4.8% (18/372) for neonatal patients. The scoping review and the manuscript will be completed by December 2020. Conclusions Results of this review will guide researchers in determining gaps and shortcomings in the current evidence base for CCDS system use and evaluation in the early detection of sepsis. The findings will be shared with key stakeholders in clinical care, research, policy, and patient advocacy. International Registered Report Identifier (IRRID) PRR1-10.2196/24899

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Digital Alerting and Outcomes in Patients With Sepsis: Systematic Review and Meta-Analysis

Cited by 48 publications

References 42 publications

Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis

Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis

Fluid Administration in Emergency Room Limited by Lung Ultrasound in Patients with Sepsis: Protocol for a Prospective Phase II Multicenter Randomized Controlled Trial

Use and Evaluation of Computerized Clinical Decision Support Systems for Early Detection of Sepsis in Hospitals: Protocol for a Scoping Review

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