{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:20:58Z","timestamp":1785907258897,"version":"3.56.0"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2015,10,16]],"date-time":"2015-10-16T00:00:00Z","timestamp":1444953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K23 HD 082368"],"award-info":[{"award-number":["K23 HD 082368"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["K23\u2010GM110496"],"award-info":[{"award-number":["K23\u2010GM110496"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective was to compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis\/septic shock in a pediatric emergency department (ED).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis\/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 19,524 eligible patient visits, 88 patients developed consensus\u2010confirmed severe sepsis or septic shock. Physician judgment identified 159 and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% confidence interval [CI] = 72.1% to 73.4%) and specificity of 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity of 92.1% (95% CI = 91.7% to 92.4%) and specificity of 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis\/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment versus algorithmic alert were 40.3% versus 2.5% and 99.88% versus 99.96%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12814","type":"journal-article","created":{"date-parts":[[2015,10,16]],"date-time":"2015-10-16T22:19:24Z","timestamp":1445033964000},"page":"1298-1306","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department"],"prefix":"10.1111","volume":"22","author":[{"given":"Fran","family":"Balamuth","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA"},{"name":"Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness Children's Hospital of Philadelphia Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Alpern","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Northwestern University Feinberg School of Medicine and Division of Emergency Medicine Ann and Robert H. Lurie Children's Hospital of Chicago Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Grundmeier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA"},{"name":"Center for Biomedical Informatics Children's Hospital of Philadelphia Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Chilutti","sequence":"additional","affiliation":[{"name":"Center for Biomedical Informatics Children's Hospital of Philadelphia Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care University of Pennsylvania Perelman School of Medicine Philadelphia PA"},{"name":"Division of Critical Care Children's Hospital of Philadelphia Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C.","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care University of Pennsylvania Perelman School of Medicine Philadelphia PA"},{"name":"Division of Critical Care Children's Hospital of Philadelphia Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Hayes","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness Children's Hospital of Philadelphia Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"Bilker","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebbing","family":"Lautenbach","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Perelman School of Medicine Philadelphia PA"},{"name":"Department of Medicine Division of Infectious Diseases University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,10,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1402564"},{"key":"e_1_2_7_3_1","first-page":"469","article-title":"Suboptimal care in the initial management of children who died from severe bacterial infection: a population\u2010based confidential inquiry","volume":"11","author":"Launay E","year":"2010","journal-title":"Pediatr Crit Care Med"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1085-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-2895"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-3513"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000509"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2015.03.012"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12014"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12610"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-013-9445-6"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.12.008"},{"key":"e_1_2_7_13_1","unstructured":"The Algorithmic Alert Sepsis Collaborative. Homepage. Available at:http:\/\/quality.pemfellows.com\/. Accessed Sep 1 2015."},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000149131.72248.E6"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31819323c6"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-199"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3871"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000743"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1400276"},{"key":"e_1_2_7_21_1","unstructured":"New York State.Hospital Sepsis Protocols. Available at:https:\/\/www.health.ny.gov\/regulations\/recently_adopted\/docs\/2013-05-01_hospital_sepsis_protocols.pdf. 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