{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:24:13Z","timestamp":1792027453009,"version":"4.4.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008173","name":"Intermountain Research and Medical Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008173","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["K23GM129661"],"award-info":[{"award-number":["K23GM129661"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T35HL007744"],"award-info":[{"award-number":["T35HL007744"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Guidelines emphasize rapid antibiotic treatment for sepsis, but infection presence is often uncertain at initial presentation. We investigated the incidence and drivers of false-positive presumptive infection diagnosis among emergency department (ED) patients meeting Sepsis-3 criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>For a retrospective cohort of patients hospitalized after meeting Sepsis-3 criteria (acute organ failure and suspected infection including blood cultures drawn and intravenous antimicrobials administered) in 1 of 4 EDs from 2013 to 2017, trained reviewers first identified the ED-diagnosed source of infection and adjudicated the presence and source of infection on final assessment. Reviewers subsequently adjudicated final infection probability for a randomly selected 10% subset of subjects. Risk factors for false-positive infection diagnosis and its association with 30-day mortality were evaluated using multivariable regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 8267 patients meeting Sepsis-3 criteria in the ED, 699 (8.5%) did not have an infection on final adjudication and 1488 (18.0%) patients with confirmed infections had a different source of infection diagnosed in the ED versus final adjudication (ie, initial\/final source diagnosis discordance). Among the subset of patients whose final infection probability was adjudicated (n = 812), 79 (9.7%) had only \u201cpossible\u201d infection and 77 (9.5%) were not infected. Factors associated with false-positive infection diagnosis included hypothermia, altered mental status, comorbidity burden, and an \u201cunknown infection source\u201d diagnosis in the ED (odds ratio: 6.39; 95% confidence interval: 5.14\u20137.94). False-positive infection diagnosis was not associated with 30-day mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this large multihospital study, &amp;lt;20% of ED patients meeting Sepsis-3 criteria had no infection or only possible infection on retrospective adjudication.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad101","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T07:51:34Z","timestamp":1676879494000},"page":"2047-2055","source":"Crossref","is-referenced-by-count":34,"title":["Concordance Between Initial Presumptive and Final Adjudicated Diagnoses of Infection Among Patients Meeting Sepsis-3 Criteria in the Emergency Department"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4625-2065","authenticated-orcid":false,"given":"Gabriel A","family":"Hooper","sequence":"first","affiliation":[{"name":"University of Utah School of Medicine , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn J","family":"Klippel","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center , Murray, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra R","family":"McLean","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine , Salt Lake City, Utah , USA"},{"name":"Department of Physical Medicine and Rehabilitation, University of North Carolina Health , Chapel Hill, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A","family":"Stenehjem","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Epidemiology, Department of Medicine, Intermountain Medical Center , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon J","family":"Webb","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Wisconsin School of Medicine , Madison, Wisconsin , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily R","family":"Murnin","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine , Salt Lake City, Utah , USA"},{"name":"Department of Medicine, University of Wisconsin School of Medicine , Madison, Wisconsin , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine L","family":"Hough","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Oregon Health and Sciences University , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R","family":"Bledsoe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Intermountain Medical Center , Murray, Utah , USA"},{"name":"Department of Emergency Medicine, Stanford University , Palo Alto, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel M","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center , Murray, Utah , USA"},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1730-234X","authenticated-orcid":false,"given":"Ithan D","family":"Peltan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center , Murray, Utah , USA"},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of 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