Early clinical evaluation of a vendor developed pediatric artificial intelligence sepsis model in the emergency department.

Abstract

Objective: To conduct an independent external validation of an implemented vendor-developed emergency department (ED) pediatric sepsis predictive model.

Materials and methods: We performed a retrospective cross-sectional study within 2 ED sites of a large pediatric health system between January 1, 2021 and April 1, 2024. A nurse-facing interruptive alert appeared when the model score exceeded the threshold, triggering clinicians to call a sepsis huddle. We compared model predictive performance with vendor-reported performance using definitions that accounted for model threshold and alert timing in clinical practice. Care processes and patient outcome measures included time to first antibiotics, time to first fluid bolus, 30-day mortality, ED to ICU admission rate, and ICU free days.

Results: The pre-intervention cohort consisted of 268 102 ED visits with 741 (0.28%) sepsis cases. The post-intervention cohort consisted of 331 061 ED visits with 1114 (0.34%) sepsis cases. Model predictive performance dropped from vendor-reported performance. Mean time to first antibiotic decreased from 112 to 102 minutes (P = .05, 95% confidence interval of difference, -19.1 to 0.1) and time to first bolus decreased by 16.7 minutes (P = .03, 95% confidence interval difference, -31.8 to -1.5) after the intervention. Decreases in 30-day mortality (6% [45/741] to 4% [52/1114]); ED to ICU admissions (87% [646/741] to 84% [941/1114]), and ICU free days (6 to 5) after the intervention did not meet statistical significance.

Discussion: Implementing the model led to significant reductions in time to fluid bolus and borderline decreases in time to antibiotics, with non-significant changes in mortality and ICU metrics. When implementing an externally developed model, local workflows, documentation patterns, and patient populations make it challenging to generalize published or reported model performance metrics to real world performance.

Conclusion: When tailoring a vendor-developed pediatric ED sepsis model for real-world usage, predictive performance differed substantially. Post-implementation we found improvements in care process measures, suggesting such models may benefit sepsis care when adapted for specific clinical workflows.