{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T12:55:13Z","timestamp":1787662513061,"version":"build-2736575974"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Our aim was to design and validate a software application, based on the Sepsis-3 criteria, capable of retrospectively identifying community-onset sepsis among emergency department patients requiring hospital admission.The application was developed using QlikView (Qlik, King of Prussia, PA, USA) software, and accessed data from the electronic health records TakeCare (CompuGroup Medical, Koblenz, Germany), and CliniSoft (CliniSoft, Kuopio, Finland). The application utilized indicators such as blood culture data, antibiotic administration, and Sequential Organ Failure Assessment scores to detect sepsis cases according to Sepsis-3 criteria. The application was tested retrospectively against a cohort from a large city hospital in Stockholm over a 2-year period, and its performance was compared to physician record reviews in a subset of cases identified by stratified random sampling. The results showed that among 229,195 emergency department visits leading to 60,213 hospital admissions, the application detected 7027 cases of sepsis. Validation using physician record review of a random selection of 426 cases demonstrated a sensitivity, specificity, positive predictive value, and negative predictive value of 95%, 99%, 92%, and 99%, respectively. The lower respiratory tract was the most common site of infection. This software application effectively identified community-onset sepsis patients using electronic health record data with high performance. It has the potential to improve sepsis identification as it operates independently of diagnostic codes and may, therefore, facilitate research in many areas of sepsis. Furthermore, it can be used as a tool within the healthcare system to enhance sepsis surveillance and evaluate quality improvement interventions.<\/jats:p>","DOI":"10.1038\/s41598-025-99879-9","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T10:38:24Z","timestamp":1747046304000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Validation of a software application using electronic health records for automatic detection of community onset sepsis"],"prefix":"10.1038","volume":"15","author":[{"given":"Cristian","family":"Dur\u00e9","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Jonmarker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Joelsson-Alm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hampus","family":"Nordqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Bohm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liivi","family":"Rimling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael Andersson","family":"Franko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Cronhjort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"\u00c4ngeby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"99879_CR1","unstructured":"WHO, W.H.O. Protocol for the assessment of national communicable disease surveillance and response systems: Guidelines for assessment teams. 2017 9 January 2017; Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/273181\/B140_12-en.pdf?sequence=1&isAllowed=y."},{"issue":"8","key":"99879_CR2","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","volume":"315","author":"M Singer","year":"2016","unstructured":"Singer, M. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315(8), 801\u2013810 (2016).","journal-title":"JAMA"},{"key":"99879_CR3","unstructured":"Benjamin Flam, A.O.S.n.d.o.k.f.L.s.M.K.-.-c., 113:DY3A; Available from: https:\/\/lakartidningen.se\/klinik-och-vetenskap-1\/kommentar\/2016\/03\/sepsis-nya-definitioner-och-kriterier-foreslas\/."},{"key":"99879_CR4","unstructured":"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sepsis., W.H.O.S.A.f."},{"issue":"8","key":"99879_CR5","doi-asserted-by":"publisher","first-page":"e2331168","DOI":"10.1001\/jamanetworkopen.2023.31168","volume":"6","author":"LWE Mellhammar","year":"2023","unstructured":"Mellhammar, L. W. E. et al. Estimating sepsis incidence using administrative data and clinical medical record review. JAMA Netw. Open. 6(8), e2331168. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.31168 (2023).","journal-title":"JAMA Netw. Open."},{"key":"99879_CR6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad491","author":"LZJ Ling","year":"2023","unstructured":"Ling, L. Z. J. et al. Population sepsis incidence, mortality, and trends in Hong Kong between 2009\u20132018 using clinical and administrative data. Clin. Infect Dis. https:\/\/doi.org\/10.1093\/cid\/ciad491 (2023).","journal-title":"Clin. Infect Dis."},{"issue":"9","key":"99879_CR7","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1136\/bmjqs-2019-010123","volume":"29","author":"JKWL Valik","year":"2020","unstructured":"Valik, J. K. W. L. et al. Validation of automated sepsis surveillance based on the Sepsis-3 clinical criteria against physician record review in a general hospital population: Observational study using electronic health records data. BMJ Qual. Saf. 29(9), 735\u2013745 (2020).","journal-title":"BMJ Qual. Saf."},{"key":"99879_CR8","unstructured":"Evans, L., Rhodes, A., Alhazzani, W. et al. Surviving sepsis campaign: international guidelines for management ofsepsis and septic shock 2021. Intensive Care. Med. 47, 1181\u20131247 (2021)."},{"issue":"4","key":"99879_CR9","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1097\/CCM.0000000000002965","volume":"46","author":"AEW Johnson","year":"2018","unstructured":"Johnson, A. E. W. et al. A comparative analysis of sepsis identification methods in an electronic database. Crit. Care Med. 46(4), 494\u2013499. https:\/\/doi.org\/10.1097\/CCM.0000000000002965 (2018).","journal-title":"Crit. Care Med."},{"issue":"6","key":"99879_CR10","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1097\/CCM.0b013e3181de4406","volume":"38","author":"SB Wilhelms","year":"2010","unstructured":"Wilhelms, S. B., Granath, G. & Sj\u00f6berg, F. Assessment of incidence of severe sepsis in Sweden using different ways of abstracting International Classification of Diseases codes: Difficulties with methods and interpretation of results. Crit. Care Med. 38(6), 1442\u20131449. https:\/\/doi.org\/10.1097\/CCM.0b013e3181de4406 (2010).","journal-title":"Crit. Care Med."},{"issue":"13","key":"99879_CR11","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1001\/jama.2017.13836","volume":"318","author":"C Rhee","year":"2017","unstructured":"Rhee, C. et al. Incidence and trends of sepsis in us hospitals using clinical vs claims data, 2009\u20132014. JAMA 318(13), 1241\u20131249. https:\/\/doi.org\/10.1001\/jama.2017.13836 (2017).","journal-title":"JAMA"},{"key":"99879_CR12","unstructured":"Johansson D, E.H., Beronius E, Rasmussen M. Systematisk journalgranskning i Sk\u00e5ne - Diagnoskoder var ofta fel vid sv\u00e5r sepsis och septisk chock [Systematic medical record review in Sk\u00e5ne. Diagnostic codes were often wrong in severe sepsis and septic shock]. Lakartidningen. 2015 Sep 14;112:DI7S. Swedish. 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Epidemiology of hospital-onset versus community-onset sepsis in US hospitals and association with mortality: A retrospective analysis using electronic clinical data. Crit. Care Med. 47(9), 1169\u20131176. https:\/\/doi.org\/10.1097\/CCM.0000000000003817 (2019).","journal-title":"Crit. Care Med."},{"key":"99879_CR16","unstructured":"Infektionsl\u00e4karf\u00f6rening. S. Sepsis och septisk chock \u2013 V\u00e5rdprogram fr\u00e5n SILF. . [cited 2022. https:\/\/infektion.net\/knowledge\/vardprogrammet-for-sepsis-och-septisk-chock\/."},{"key":"99879_CR17","unstructured":"Shrirang M Gadrey1, C.E.L., RussClay, Garret TRhodes, Douglas E Lake, ChristopherC Moore,, and J.D.A.J. Moorman. Imputation of partial pressures of arterial oxygen using oximetry."},{"issue":"8","key":"99879_CR18","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.1097\/MLR.0000000000000324","volume":"55","author":"GM Cadieux","year":"2017","unstructured":"Cadieux, G. M., Tamblyn, R., Buckeridge, D. L. & Dendukuri, N. Validation of diagnostic groups based on health care utilization data should adjust for sampling strategy. Med. Care. 55(8), e59\u2013e67 (2017).","journal-title":"Med. Care."},{"issue":"10","key":"99879_CR19","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.1097\/CCM.0b013e3182923712","volume":"41","author":"PM Klein Klouwenberg","year":"2013","unstructured":"Klein Klouwenberg, P. M. et al. Interobserver agreement of centers for disease control and prevention criteria for classifying infections in critically ill patients. Crit. Care Med. 41(10), 2373\u20132378. https:\/\/doi.org\/10.1097\/CCM.0b013e3182923712 (2013).","journal-title":"Crit. Care Med."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-99879-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-99879-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-99879-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T10:38:31Z","timestamp":1747046311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-99879-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["99879"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-99879-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]},"assertion":[{"value":"28 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Swedish Ethical Review Authority (Ref. number 2018\/56931 and complementary ethical permit Ref. number 2019\/02683 and Ref. number 2021\/00446). The need for obtaining informed consent was waived by the Swedish Ethical Review Authority due to the retrospective nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"16412"}}