Detection of sepsis during emergency department triage using machine learning

Abstract: Sepsis is a life-threatening condition with organ dysfunction and is a leading cause of death and critical illness worldwide. Even a few hours of delay in the treatment of sepsis results in increased mortality. Early detection of sepsis during emergency department triage would allow early initiation of lab analysis, antibiotic administration, and other sepsis treatment protocols. The purpose of this study was to compare sepsis detection performance at ED triage (prior to the use of laboratory diagnostics) of the standard sepsis screening algorithm (SIRS with source of infection) and a machine learning algorithm trained on EHR triage data. A machine learning model (KATE Sepsis) was developed using patient encounters with triage data from 16participating hospitals. KATE Sepsis and standard screening were retrospectively evaluated on the adult population of 512,949 medical records. KATE Sepsis demonstrates an AUC of 0.9423 (0.9401 - 0.9441) with sensitivity of 71.09% (70.12% - 71.98%) and specificity of 94.81% (94.75% - 94.87%). Standard screening demonstrates an AUC of 0.6826 (0.6774 - 0.6878) with sensitivity of 40.8% (39.71% - 41.86%) and specificity of 95.72% (95.68% - 95.78%). The KATE Sepsis model trained to detect sepsis demonstrates 77.67% (75.78% -79.42%) sensitivity in detecting severe sepsis and 86.95% (84.2% - 88.81%) sensitivity in detecting septic shock. The standard screening protocol demonstrates 43.06% (41% - 45.87%) sensitivity in detecting severe sepsis and40% (36.55% - 43.26%) sensitivity in detecting septic shock. Future research should focus on the prospective impact of KATE Sepsis on administration of antibiotics, readmission rate, morbidity and mortality.