Critical care explorations最新文献

{"title":"Prevalence of Pulmonary Embolism in COVID-19 Positive Critically Ill Children.","authors":"Yudy Fonseca, Alise Davies, Stephanie Jarrin, Liliana Simon, Cortney Foster, Sun Kai, Adnan Bhutta","doi":"10.1097/CCE.0000000000001206","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001206","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the prevalence of pulmonary embolism (PE) in children admitted to critical care diagnosed with COVID-19 infection.</p><p><strong>Design: </strong>Retrospective database study.</p><p><strong>Setting: </strong>Data reported to the Virtual Pediatric Systems, 2018-2021.</p><p><strong>Patients: </strong>Patients 28 days to younger than 18 years old, admitted to a PICU with either PE or COVID-19 diagnoses.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among the PE-positive subgroups, from January 2020 to December 2021, 78 patients (14%) had an acute COVID-19 infection. The prevalence of PE pre-pandemic period (2018-2019) was 0.19% and for pandemic period (2020-2021) was 0.26% (p < 0.001). During the pandemic period, the prevalence of PE for COVID-negative patients was 0.21% and for COVID-positive patients was 1.01% (p < 0.001). The result shows that the chance to develop PE for COVID-positive patients is 4.8 times that for COVID-negative patients during the pandemic. In the subgroup of the PE-positive patients, 55.1% were Black or African American in the COVID-positive group and 19% in the COVID-negative group (p < 0.001). A multivariable logistic regression showed that race was an independent risk factor for COVID in PE-positive patients.</p><p><strong>Conclusions: </strong>Our study demonstrates a significant increase in the prevalence of PE among pediatric patients admitted to PICUs during the COVID-19 pandemic compared with pre-pandemic. Our study indicates that COVID-positive patients are 4.8 times more likely to develop PE than COVID-negative patients. Additionally, the study highlights substantial racial disparities in the prevalence of PE, with Black or African American patients being disproportionately affected.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1206"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic.","authors":"Rachel L Winner, Lydia R Ware, Kevin M Dube, Mary P Kovacevic, Kenneth E Lupi, Paul M Szumita, Jeremy R DeGrado","doi":"10.1097/CCE.0000000000001202","DOIUrl":"10.1097/CCE.0000000000001202","url":null,"abstract":"<p><strong>Importance: </strong>Recent studies have found an association between COVID-19 infection and deeper sedation in mechanically ventilated patients, raising concerns about the impact of the COVID-19 pandemic on pain, agitation, and delirium (PAD) management practices overall.</p><p><strong>Objectives: </strong>This study aimed to assess differences in PAD management in patients without COVID-19 infection in pre- and peri-COVID-19 pandemic timeframes.</p><p><strong>Design, setting, and participants: </strong>This was a single-center, retrospective, pre-/post-cohort analysis of mechanically ventilated adult patients without COVID-19 infection admitted to an ICU in Boston, MA. The \"pre\" and \"post\" groups enrolled patients in 2019 and 2021, respectively. All PAD data during the first 7 days of mechanical ventilation (MV) were collected.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was ventilator-free days (VFDs) during the first 28 days. A multivariable linear regression analysis was performed to assess VFD while controlling for confounders. Secondary outcomes included depth of sedation, total dose of sedatives, and in-hospital mortality.</p><p><strong>Results: </strong>There were 339 patients included in the final analysis. There was no difference in VFD between the pre- and post-groups (22.2 vs. 22.6 d; p = 0.92); this was confirmed by multivariable linear regression (p = 0.91). Patients in the post-group experienced significantly deeper levels of sedation compared with the pre-group (58% vs. 53%; p < 0.01) within the first 48 hours of MV. The median number of Richmond Agitation-Sedation Scale assessments per 24-hour period was greater in the pre-group (13 vs. 12 assessments; p = 0.02) within the first 48 hours of MV. There were no significant differences in total cumulative dose of sedatives or in-hospital mortality between the two groups.</p><p><strong>Conclusions and relevance: </strong>This study suggests that PAD practices, including depth of sedation and frequency of assessment, differed between pre- and post-COVID-19 groups in patients without COVID-19. Outcomes including VFD, mortality, and hospital length of stay were not affected. Further studies are needed to understand the broader impact of the COVID-19 pandemic on PAD management practices.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1202"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Pulmonary Embolism in COVID-19 Positive Critically Ill Children.","authors":"Yudy Fonseca, Alise Davies, Stephanie Jarrin, Liliana Simon, Cortney Foster, Sun Kai, Adnan Bhutta","doi":"10.1097/CCE.0000000000001206","DOIUrl":"10.1097/CCE.0000000000001206","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the prevalence of pulmonary embolism (PE) in children admitted to critical care diagnosed with COVID-19 infection.</p><p><strong>Design: </strong>Retrospective database study.</p><p><strong>Setting: </strong>Data reported to the Virtual Pediatric Systems, 2018-2021.</p><p><strong>Patients: </strong>Patients 28 days to younger than 18 years old, admitted to a PICU with either PE or COVID-19 diagnoses.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among the PE-positive subgroups, from January 2020 to December 2021, 78 patients (14%) had an acute COVID-19 infection. The prevalence of PE pre-pandemic period (2018-2019) was 0.19% and for pandemic period (2020-2021) was 0.26% (<i>p</i> < 0.001). During the pandemic period, the prevalence of PE for COVID-negative patients was 0.21% and for COVID-positive patients was 1.01% (<i>p</i> < 0.001). The result shows that the chance to develop PE for COVID-positive patients is 4.8 times that for COVID-negative patients during the pandemic. In the subgroup of the PE-positive patients, 55.1% were Black or African American in the COVID-positive group and 19% in the COVID-negative group (<i>p</i> < 0.001). A multivariable logistic regression showed that race was an independent risk factor for COVID in PE-positive patients.</p><p><strong>Conclusions: </strong>Our study demonstrates a significant increase in the prevalence of PE among pediatric patients admitted to PICUs during the COVID-19 pandemic compared with pre-pandemic. Our study indicates that COVID-positive patients are 4.8 times more likely to develop PE than COVID-negative patients. Additionally, the study highlights substantial racial disparities in the prevalence of PE, with Black or African American patients being disproportionately affected.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1206"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure: Systematic Review and Meta-Analysis.","authors":"Robert S Brown, Robert A Fisher, Ram M Subramanian, Adam Griesemer, Milene Fernandes, William H Thatcher, Kathryn Stiede, Michael Curtis","doi":"10.1097/CCE.0000000000001199","DOIUrl":"10.1097/CCE.0000000000001199","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the safety and efficacy of nonbiological (NBAL) or biological artificial liver support systems (BAL) and whole-organ extracorporeal liver perfusion (W-ECLP) systems, in adults with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF).</p><p><strong>Data sources: </strong>Eligible NBAL/BAL studies from PubMed/Embase searches were randomized controlled trials (RCTs) in adult patients with ALF/ACLF, greater than or equal to ten patients per group, reporting outcomes related to survival, adverse events, transplantation rate, and hepatic encephalopathy, and published in English from January 2000 to July 2023. Separately, we searched for studies evaluating W-ECLP in adult patients with ALF or ACLF published between January1990 and July 2023.</p><p><strong>Study selection and data extraction: </strong>Two researchers independently screened citations for eligibility and, of eligible studies, retrieved data related to study characteristics, patients and interventions, outcomes definition, and intervention effects. The Cochrane Risk of Bias 2 tool and Joanna Briggs Institute checklists were used to assess individual study risk of bias. Meta-analysis of mortality at 28-30 days post-support system initiation and frequency of at least one serious adverse event (SAE) generated pooled risk ratios (RRs), based on random (mortality) or fixed (SAE) effects models.</p><p><strong>Data synthesis: </strong>Of 17 trials evaluating NBAL/BAL systems, 11 reported 28-30 days mortality and five reported frequency of at least one SAE. Overall, NBAL/BAL was not statistically associated with mortality at 28-30 days (RR, 0.85; 95% CI, 0.67-1.07; p = 0.169) or frequency of at least one SAE (RR, 1.15; 95% CI, 0.99-1.33; p = 0.059), compared with standard medical treatment. Subgroup results on ALF patients suggest possible benefit for mortality (RR, 0.67; 95% CI, 0.44-1.03; p = 0.069). From six reports of W-ECLP (12 patients), more than half (58%) of severe patients were bridged to transplantation and survived without transmission of porcine retroviruses.</p><p><strong>Conclusions: </strong>Despite no significant pooled effects of NBAL/BAL devices, the available evidence calls for further research and development of extracorporeal liver support systems, with larger RCTs and optimization of patient selection, perfusion durability, and treatment protocols.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1199"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Electrical Impedance Imaging During Spontaneous Breathing Trials in Patients With Acute Hypoxic Respiratory Failure: A Pilot Study.","authors":"Nilton Barbosa da Rosa, Tzu-Jen Kao, John Brinton, Patrick J Offner, Ellen L Burnham, Jennifer L Mueller","doi":"10.1097/CCE.0000000000001198","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001198","url":null,"abstract":"<p><p>The purpose of this work is to evaluate the feasibility of lung imaging using 3D electrical impedance tomography (EIT) during spontaneous breathing trials (SBTs) in patients with acute hypoxic respiratory failure. EIT is a noninvasive, nonionizing, real-time functional imaging technique, suitable for bedside monitoring in critically ill patients. EIT data were collected in 24 mechanically ventilated patients immediately preceding and during a SBT on two rows of 16 electrodes using a simultaneous multicurrent source EIT system for 3D imaging. Dynamic 3D EIT images of conductivity were computed, as well as the EIT-derived rapid shallow breathing index, regional ventilation delay, global inhomogeneity index, and time traces of tidal volumes. 3D reconstructions and derived measures demonstrated inhomogeneity in ventilation distribution within patients. We conclude that 3D EIT images can provide information regarding ventilatory heterogeneity across the lung and may be useful in guiding ventilator management.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1198"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Representation of Hispanic Patients in Clinical Trials for Respiratory Failure: A Systematic Review.","authors":"Emily A Harlan, Kaitlin Malley, Grecia Quiroga, Eman Mubarak, Pema Lama, Amanda Schutz, Adolfo Cuevas, Catherine L Hough, Theodore J Iwashyna, Mari Armstrong-Hough, Thomas S Valley","doi":"10.1097/CCE.0000000000001193","DOIUrl":"10.1097/CCE.0000000000001193","url":null,"abstract":"<p><strong>Objectives: </strong>Hispanic individuals comprise one-fifth of the U.S. population and Hispanic patients with acute hypoxemic respiratory failure (AHRF) experience higher odds of death compared with non-Hispanic White patients. Representation of Hispanic patients in clinical trials for respiratory failure is critical to address this inequity. We conducted a systematic review to examine the inclusion of Hispanic patients in randomized controlled trials for AHRF and assessed language as a potential barrier to enrollment.</p><p><strong>Data sources: </strong>National Library of Medicine PubMed, Elsevier Embase, and Cochrane Central Register of Controlled Trials databases through January 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials assessing AHRF interventions enrolling U.S. patients receiving mechanical ventilation, noninvasive mechanical ventilation, or high-flow nasal cannula were included. The systematic review was registered prospectively through PROSPERO (CRD42023437828).</p><p><strong>Data extraction: </strong>Two authors independently screened studies and extracted data for each included study.</p><p><strong>Data synthesis: </strong>Ninety-four trials published from 1975 to 2023 were included; 33.0% (n = 31) of studies reported ethnicity, and 11.2% of participants in studies reporting race or ethnicity (1,320/11,780) were identified as Hispanic. The proportion of Hispanic-identified participants was significantly lower than the U.S. Hispanic population from 1996 to 2019 (p < 0.01). Starting in 2020, the proportion of Hispanic-identified participants was significantly higher than the U.S. population (27.8% vs. 19.1%; p < 0.01). Two studies (4.9%) reporting race or ethnicity excluded non-English speaking participants; the remainder did not specify language requirements for enrollment.</p><p><strong>Conclusions: </strong>Hispanic-identified individuals were underrepresented in trials for AHRF until 2020 when Hispanic patient representation increased during COVID-19. Exclusion of participants who do not speak English may represent a barrier to trial enrollment.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding ICU Nursing Knowledge, Perceived Barriers, and Facilitators of Sepsis Recognition and Management: A Cross-Sectional Study.","authors":"Katherine A Kissel, Karla D Krewulak, Thérèse G Poulin, Ken Kuljit S Parhar, Daniel J Niven, Vanessa M Doiron, Kirsten M Fiest","doi":"10.1097/CCE.0000000000001200","DOIUrl":"10.1097/CCE.0000000000001200","url":null,"abstract":"<p><strong>Importance: </strong>Nursing workforce changes, knowledge translation gaps, and environmental/organizational barriers may impact sepsis recognition and management within the ICU.</p><p><strong>Objectives: </strong>To: 1) evaluate current ICU nursing knowledge of sepsis recognition and management, 2) explore individual and environmental or organizational factors impacting nursing recognition and management of sepsis using the Theoretical Domains Framework (TDF), and 3) describe perceived barriers and facilitators to nursing recognition and management of patients with sepsis.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional survey was administered to nurses working in four general system ICUs between October 24, 2023, and January 30, 2024.</p><p><strong>Main outcomes and measures: </strong>Quantitative questions (single/multiple choice, true/false, and Likert-based questions eliciting agreement with a statement) were analyzed using descriptive statistics. Open-ended questions exploring barriers and facilitators to sepsis recognition and management were analyzed using qualitative content analysis.</p><p><strong>Results: </strong>A total of 101 completed survey responses were retained. Most nurses agreed early sepsis detection saves lives (n = 98, 97%, TDF domain Beliefs About Consequences) and that nursing care can improve patient outcomes (n = 97, 96%, TDF domain Optimism). Fewer nurses agreed it was easy to identify priority sepsis interventions based on order urgency (n = 53, 53%, TDF domain Memory, Attention, and Decision Processes). Reoccurring barriers and facilitators to sepsis recognition and management were commonly identified across the TDF domains of Knowledge, Skills, Environmental Context and Resources, and Social Influences, including competency deficit (with facilitators including support from colleagues), workload or staffing, and equipment or resource availability.</p><p><strong>Conclusion and relevance: </strong>ICU nursing sepsis recognition and management is impacted by numerous individual, environmental, and organizational factors. Recommendations include enhanced competency development or support, utilization of structured reinforcement measures (involving the interdisciplinary team and imploring the use of integrative technologies), and addressing equipment/resource-related gaps. Future research and improvement initiatives should use a theory-informed approach to overcome the pervasive, complex challenges impeding timely sepsis recognition and management.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1200"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Electrical Impedance Imaging During Spontaneous Breathing Trials in Patients With Acute Hypoxic Respiratory Failure: A Pilot Study.","authors":"Nilton Barbosa da Rosa, Tzu-Jen Kao, John Brinton, Patrick J Offner, Ellen L Burnham, Jennifer L Mueller","doi":"10.1097/CCE.0000000000001198","DOIUrl":"10.1097/CCE.0000000000001198","url":null,"abstract":"<p><p>The purpose of this work is to evaluate the feasibility of lung imaging using 3D electrical impedance tomography (EIT) during spontaneous breathing trials (SBTs) in patients with acute hypoxic respiratory failure. EIT is a noninvasive, nonionizing, real-time functional imaging technique, suitable for bedside monitoring in critically ill patients. EIT data were collected in 24 mechanically ventilated patients immediately preceding and during a SBT on two rows of 16 electrodes using a simultaneous multicurrent source EIT system for 3D imaging. Dynamic 3D EIT images of conductivity were computed, as well as the EIT-derived rapid shallow breathing index, regional ventilation delay, global inhomogeneity index, and time traces of tidal volumes. 3D reconstructions and derived measures demonstrated inhomogeneity in ventilation distribution within patients. We conclude that 3D EIT images can provide information regarding ventilatory heterogeneity across the lung and may be useful in guiding ventilator management.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1198"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Complete Blood Count Sepsis Index Using Monocyte Distribution Width for Early Detection of Sepsis in Patients Without Obvious Signs.","authors":"Scott Levin, Nima Sarani, Jeremiah Hinson, Melissa Naiman, Chad Cannon, Aria Smith, Benjamin Steinhart, Arnaud DeBraine, Sarah Kehoe, Bryan Immhoff, Yasir Taribichi, Alexandra Malinovska, Kemi Badaki-Makun","doi":"10.1097/CCE.0000000000001194","DOIUrl":"10.1097/CCE.0000000000001194","url":null,"abstract":"<p><strong>Objectives: </strong>Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Setting: </strong>The ED of the University of Kansas Medical Center, United States.</p><p><strong>Patients: </strong>All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care.</p><p><strong>Interventions: </strong>MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis.</p><p><strong>Measurements and main results: </strong>In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81-0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9-86.2%) and specificity of 64.8% (95% CI, 64.0-65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2-88.9%) sensitivity and 69.1% (95% CI, 68.3-69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs.</p><p><strong>Conclusions: </strong>The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 1","pages":"e1194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Electronic Health Records to Identify the Daily Primary Provider During Hospitalization.","authors":"Nicholas E Ingraham, Daniel Shyu, Tom Phelan, Nathan Mesfin, Benjamin Langworthy, Rachel Kohn, Meeta Prasad Kerlin, R Adams Dudley","doi":"10.1097/CCE.0000000000001189","DOIUrl":"10.1097/CCE.0000000000001189","url":null,"abstract":"<p><strong>Objectives: </strong>Providers vary in their impact on clinical outcomes, but this is rarely accounted for in healthcare research. By failing to identify the provider responsible for a patient's care, investigators miss an opportunity to account for nonrandom variation in outcomes. Prior methods of identifying responsible providers have relied on manual chart review, which is time-consuming and expensive, or analysis of claims data, which has been demonstrated to be inaccurate. To address these gaps, we sought to develop an algorithm using electronic health record (EHR) data to identify the responsible provider for each day of a patient's hospitalization.</p><p><strong>Design: </strong>A multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Midwest healthcare system.</p><p><strong>Patients: </strong>Hospitalized patients and their providers.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We first confirmed high inter-rater reliability of manual chart review to identify the responsible provider. Using manual chart review as the gold standard, we then assessed the accuracy of an automated algorithm in a set of randomly selected patients. The agreement between two independent physicians in their determination of the responsible provider by chart review was 100%. Among 200 randomly selected patients, the algorithm identified the same responsible provider as the physician chart reviewer on 93% (3372/3626; 95% CI, 92-94%) of patient-days.</p><p><strong>Conclusions: </strong>Readily available EHR data can be used to assign patients to providers daily with a high degree of accuracy. This methodology could be applied in healthcare research to identify sources of variation other than the intervention being studied.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1189"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}