Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients
Authors: Sarah K S Knack, Nathaniel Scott, Brian E Driver, Matthew E Prekker, Lauren Page Black, Charlotte Hopson, Ellen Maruggi, Olivia Kaus, Walker Tordsen, Michael A Puskarich
Published in: Annals of Emergency Medicine, 2024 March 26
Conclusion:
Physician gestalt within the first 15 minutes of patient presentation in the ED is a more effective predictor of sepsis than other established screening methods in critically ill adults. This suggests that early intuitive judgment by physicians could play a critical role in the timely identification and treatment of sepsis.
Methods:
- A prospective observational study at an academic urban safety-net hospital from September 2020 to May 2022.
- Participants included ED patients presenting with critical illnesses, excluding trauma, transfers, and clear-cut diagnoses.
- Emergency physicians used a visual analog scale (VAS) to rate their gestalt for sepsis at 15 and 60 minutes post patient arrival.
- The primary outcome measured was an explicit hospital discharge diagnosis of sepsis.
- Screening tools such as SIRS, SOFA, qSOFA, MEWS, and a logistic regression machine learning model (LASSO) were compared for their predictive accuracy using receiver operating characteristic analysis.
Results:
- 2,484 patient-physician interactions with 59 attending physicians were studied.
- 275 patients (11%) were diagnosed with sepsis at discharge.
- Initial VAS at 15 minutes (AUC 0.90) significantly outperformed SIRS, SOFA, qSOFA, MEWS, and the LASSO model in predicting sepsis.
- The advantage of physician gestalt over traditional screening tools remained consistent even when expanding data analysis to the first 60 minutes post-arrival.