Automated monitoring for the early detection of sepsis in patients receiving care in intensive care units

Review question:  Can automated systems for the early detection of sepsis reduce the time to treatment and improve outcomes in patients in the intensive care unit (ICU), in comparison to standard care?
cochrane-57-1Background:  Sepsis happens when a person develops an infection and their immune system overreacts to it. If sepsis is not managed it can quickly develop into septic shock, which causes organs such as the liver and heart to stop working properly. People can be affected by sepsis at any time but people in intensive care settings are more likely to be affected by it. Septic shock is fatal for 20% to 70% of people admitted to intensive care in Europe. There is no single diagnostic test that can tell if someone has sepsis or not. Instead, the results of several tests (such as blood tests) have to be reviewed along with other information about the patient (such as their medical history), and clinical observations (such as heart rate, temperature, and blood pressure). This process can be time consuming and complicated to do. People already admitted to intensive care are likely to be very unwell and it can be difficult to tell if abnormal results are because of the problem that caused them to be admitted to intensive care, or because of sepsis.
Automated monitoring systems are electronic systems that can collect and analyse information from different sources, and can be used to alert staff when the signs and symptoms of sepsis have been identified. This may mean that sepsis is diagnosed at the earliest possible time, enabling treatment to begin before organ damage happens. However, there is the possibility that automated monitoring systems don’t help, or even cause harm. This might happen if the systems are unable to correctly detect sepsis (meaning that treatment is not started when it should be, or it is started when it shouldn’t be), or health care staff may not respond to alerts quickly enough, especially if the systems give too many false alarms.
Study characteristics:  We conducted a search to identify evidence published before September 2017. Studies were eligible for inclusion if they compared automated sepsis monitoring to standard care (such as paper‐based systems) in people admitted to intensive or critical care units for critical illness. We did not include non‐randomized studies (studies where participants were not allocated to treatment groups by chance), quasi‐randomized studies (studies where participants were allocated to treatment groups by a method that is not truly down to chance, such as date of birth or medical number), and cross‐over studies (where participants first receive one treatment and then cross over to receive the other treatment). Studies including people already diagnosed with sepsis were also excluded.
Key results:  We included three randomized controlled trials (studies where participants were allocated to treatment groups by chance), involving 1199 participants in this review. Overall there were no significant differences in time to start of antimicrobial therapy (such as antimicrobial and antifungal treatments, very low‐quality evidence), length of stay in the intensive care setting (very low‐quality evidence), or in mortality at 14 days, 28 days or discharge (very low‐quality evidence) when automated monitoring systems were compared to standard care. Very low‐quality evidence was available on failed detection of sepsis but data reporting was too unclear to enable us to analyse this in a meaningful way. Other outcomes that we wished to assess like time to initiation of fluid resuscitation (the process of increasing the amount of fluids in the body), mortality at 30 days, and quality of life were not reported in any of the studies.
Quality of the evidence:  Results of this review show limited, very low‐quality evidence, which has prevented us from drawing meaningful conclusions. It is unclear what effect automated systems for monitoring sepsis have on any outcomes included in this review, and therefore we are uncertain if automated sepsis monitoring is beneficial or not. Additional, high‐quality evidence is needed to help address our review question.
The full text of this Cochrane Review is freely available via this link.

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