Clinical Scorecard: Identification of Sepsis and Septic Shock Cases Using Electronic Health Records: An Open-Source Approach and Comparative Analysis of Cohorts Based on Criteria

At a Glance

Key Highlights

• Multiple clinical criteria exist for sepsis and septic shock identification; CDC ASE and Sepsis-3 are commonly used but differ in application and performance.
• Electronic health record data workflows require extraction, transformation, and application of criteria with transparent, reproducible programming code.
• Open-source programming code for full data workflow including extraction is essential for reproducibility and external adoption but is rarely available.

Guideline-Based Recommendations

Diagnosis

• Use performance improvement programs including sepsis screening as recommended by 2021 Surviving Sepsis Campaign Guidelines.
• Apply CDC ASE criteria for sepsis surveillance as recommended by the US CDC.
• Consider Sepsis-3 clinical criteria as a gold standard for research and clinical case identification.

Management

• Identification of sepsis cases underpins quality improvement and management programs; accurate case identification is critical.

Monitoring & Follow-up

• Monitor diagnostic performance of case identification criteria compared to manual chart review to ensure validity.
• Use detailed data workflows with validation checks to maintain data integrity during extraction and transformation.

Risks

• ICD coding may be biased by provider documentation and increased sepsis awareness, affecting retrospective study accuracy.
• Variations in case identification approaches can lead to substantial differences in mortality estimates and predictive validity.

Patient & Prescribing Data

Patients with at least one microbial culture and antimicrobial dose administered during encounter

Antimicrobial administration is a key inclusion criterion for sepsis case identification workflows

Clinical Best Practices

• Develop and deploy transparent, reproducible data workflows including extraction, transformation, and criteria application steps.
• Align case identification procedures closely with original CDC ASE and Sepsis-3 criteria source documents without adaptations.
• Publish and share open-source programming code to facilitate external validation, replication, and adoption.
• Exclude encounters with inconsistent time stamps to ensure data quality.
• Use relational databases and validated software tools (e.g., R, Quarto) for data processing and analysis.

References

• 2021 Surviving Sepsis Campaign Guidelines
• CDC Adult Sepsis Event (ASE) Criteria
• Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
• OpenSep GitHub Repository