Jonathan Y Lam, Aaron Boussina, Supreeth P Shashikumar, Robert L Owens, Shamim Nemati, Christopher S Josef
{"title":"实验室数据缺失对败血症诊断及时性的影响。","authors":"Jonathan Y Lam, Aaron Boussina, Supreeth P Shashikumar, Robert L Owens, Shamim Nemati, Christopher S Josef","doi":"10.1093/jamiaopen/ooae085","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of missing laboratory measurements on sepsis diagnostic delays.</p><p><strong>Materials and methods: </strong>In adult patients admitted to 2 University of California San Diego (UCSD) hospitals from January 1, 2021 to June 30, 2024, we evaluated the relative time of organ failure (<i>T</i> <sub>OF</sub>) and time of clinical suspicion of sepsis (<i>T</i> <sub>suspicion</sub>) in patients with sepsis according to the Centers for Medicare & Medicaid Services (CMS) definition.</p><p><strong>Results: </strong>Of the patients studied, 48.7% (<i>n</i> = 2017) in the emergency department (ED), 30.8% (<i>n</i> = 209) in the wards, and 14.4% (<i>n</i> = 167) in the intensive care unit (ICU) had <i>T</i> <sub>OF</sub> after <i>T</i> <sub>suspicion</sub>. Patients with <i>T</i> <sub>OF</sub> after <i>T</i> <sub>suspicion</sub> had significantly higher data missingness of 1 or more of the 5 laboratory components used to determine organ failure. The mean number of missing labs was 4.23 vs 2.83 in the ED, 4.04 vs 3.38 in the wards, and 3.98 vs 3.19 in the ICU.</p><p><strong>Discussion: </strong>Our study identified many sepsis patients with missing laboratory results vital for the identification of organ failure and the diagnosis of sepsis at or before the time of clinical suspicion of sepsis. Addressing data missingness via more timely laboratory assessment could precipitate an earlier recognition of organ failure and potentially earlier diagnosis of and treatment initiation for sepsis.</p><p><strong>Conclusions: </strong>More prompt laboratory assessment might improve the timeliness of sepsis recognition and treatment.</p>","PeriodicalId":36278,"journal":{"name":"JAMIA Open","volume":"7 3","pages":"ooae085"},"PeriodicalIF":2.5000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418648/pdf/","citationCount":"0","resultStr":"{\"title\":\"The impact of laboratory data missingness on sepsis diagnosis timeliness.\",\"authors\":\"Jonathan Y Lam, Aaron Boussina, Supreeth P Shashikumar, Robert L Owens, Shamim Nemati, Christopher S Josef\",\"doi\":\"10.1093/jamiaopen/ooae085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate the impact of missing laboratory measurements on sepsis diagnostic delays.</p><p><strong>Materials and methods: </strong>In adult patients admitted to 2 University of California San Diego (UCSD) hospitals from January 1, 2021 to June 30, 2024, we evaluated the relative time of organ failure (<i>T</i> <sub>OF</sub>) and time of clinical suspicion of sepsis (<i>T</i> <sub>suspicion</sub>) in patients with sepsis according to the Centers for Medicare & Medicaid Services (CMS) definition.</p><p><strong>Results: </strong>Of the patients studied, 48.7% (<i>n</i> = 2017) in the emergency department (ED), 30.8% (<i>n</i> = 209) in the wards, and 14.4% (<i>n</i> = 167) in the intensive care unit (ICU) had <i>T</i> <sub>OF</sub> after <i>T</i> <sub>suspicion</sub>. Patients with <i>T</i> <sub>OF</sub> after <i>T</i> <sub>suspicion</sub> had significantly higher data missingness of 1 or more of the 5 laboratory components used to determine organ failure. The mean number of missing labs was 4.23 vs 2.83 in the ED, 4.04 vs 3.38 in the wards, and 3.98 vs 3.19 in the ICU.</p><p><strong>Discussion: </strong>Our study identified many sepsis patients with missing laboratory results vital for the identification of organ failure and the diagnosis of sepsis at or before the time of clinical suspicion of sepsis. Addressing data missingness via more timely laboratory assessment could precipitate an earlier recognition of organ failure and potentially earlier diagnosis of and treatment initiation for sepsis.</p><p><strong>Conclusions: </strong>More prompt laboratory assessment might improve the timeliness of sepsis recognition and treatment.</p>\",\"PeriodicalId\":36278,\"journal\":{\"name\":\"JAMIA Open\",\"volume\":\"7 3\",\"pages\":\"ooae085\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418648/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMIA Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/jamiaopen/ooae085\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMIA Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jamiaopen/ooae085","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
The impact of laboratory data missingness on sepsis diagnosis timeliness.
Objective: To investigate the impact of missing laboratory measurements on sepsis diagnostic delays.
Materials and methods: In adult patients admitted to 2 University of California San Diego (UCSD) hospitals from January 1, 2021 to June 30, 2024, we evaluated the relative time of organ failure (TOF) and time of clinical suspicion of sepsis (Tsuspicion) in patients with sepsis according to the Centers for Medicare & Medicaid Services (CMS) definition.
Results: Of the patients studied, 48.7% (n = 2017) in the emergency department (ED), 30.8% (n = 209) in the wards, and 14.4% (n = 167) in the intensive care unit (ICU) had TOF after Tsuspicion. Patients with TOF after Tsuspicion had significantly higher data missingness of 1 or more of the 5 laboratory components used to determine organ failure. The mean number of missing labs was 4.23 vs 2.83 in the ED, 4.04 vs 3.38 in the wards, and 3.98 vs 3.19 in the ICU.
Discussion: Our study identified many sepsis patients with missing laboratory results vital for the identification of organ failure and the diagnosis of sepsis at or before the time of clinical suspicion of sepsis. Addressing data missingness via more timely laboratory assessment could precipitate an earlier recognition of organ failure and potentially earlier diagnosis of and treatment initiation for sepsis.
Conclusions: More prompt laboratory assessment might improve the timeliness of sepsis recognition and treatment.
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