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    An evaluation of the diagnostic accuracy of the 1991 American College of Chest Physicians/Society of Critical Care Medicine and the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society sepsis definition

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    Authors
    Zhao, Huifang
    Heard, Stephen O.
    Mullen, Marie T.
    Crawford, Sybil L.
    Goldberg, Robert J.
    Frendl, Gyorgy
    Lilly, Craig M.
    UMass Chan Affiliations
    Meyers Primary Care Institute
    Department of Quantitative Health Sciences
    Department of Medicine, Division of Cardiovascular Medicine
    Department of Medicine, Division of Preventive and Behavioral Medicine
    Department of Emergency Medicine
    Department of Anesthesiology
    Graduate School of Biomedical Sciences, Clinical and Population Health Research Program
    Document Type
    Journal Article
    Publication Date
    2012-06-01
    Keywords
    Aged
    Aged, 80 and over
    Area Under Curve
    *Consensus
    Critical Care
    Europe
    Female
    Humans
    Male
    Massachusetts
    Middle Aged
    Sensitivity and Specificity
    Sepsis
    Societies, Medical
    *Terminology as Topic
    United States
    area under the ROC curve
    definition
    intensive care unit
    sepsis
    sensitivity
    Anesthesiology
    Bacterial Infections and Mycoses
    Diagnosis
    Emergency Medicine
    Pathological Conditions, Signs and Symptoms
    Preventive Medicine
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    Link to Full Text
    https://doi.org/10.1097/CCM.0b013e318246b83a
    Abstract
    OBJECTIVES: Limited research has been conducted to compare the test characteristics of the 1991 and 2001 sepsis consensus definitions. This study assessed the accuracy of the two sepsis consensus definitions among adult critically ill patients compared to sepsis case adjudication by three senior clinicians. DESIGN: Observational study of patients admitted to intensive care units. SETTING: Seven intensive care units of an academic medical center. PATIENTS: A random sample of 960 patients from all adult intensive care unit patients between October 2007 and December 2008. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Sensitivity, specificity, and the area under the receiver operating characteristic curve for the two consensus definitions were calculated by comparing the number of patients who met or did not meet consensus definitions vs. the number of patients who were or were not diagnosed with sepsis by adjudication. The 1991 sepsis definition had a high sensitivity of 94.6%, but a low specificity of 61.0%. The 2001 sepsis definition had a slightly increased sensitivity but a decreased specificity, which were 96.9% and 58.3%, respectively. The areas under the receiver operating characteristic curve for the two definitions were not statistically different (0.778 and 0.776, respectively). The sensitivities and areas under the receiver operating characteristic curve of both definitions were lower at the 24-hr time window level than those of the intensive care unit stay level, though their specificities increased slightly. Fever, high white blood cell count or immature forms, low Glasgow coma score, edema, positive fluid balance, high cardiac index, low PaO2/FIO2 ratio, and high levels of creatinine and lactate were significantly associated with sepsis by both definitions and adjudication. CONCLUSIONS: Both the 1991 and the 2001 sepsis definition have a high sensitivity but low specificity; the 2001 definition has a slightly increased sensitivity but a decreased specificity compared to the 1991 definition. The diagnostic performances of both definitions were suboptimal. A parsimonious set of significant predictors for sepsis diagnosis is likely to improve current sepsis case definitions.
    Source

    Crit Care Med. 2012 Jun;40(6):1700-6. Link to article on publisher's site

    DOI
    10.1097/CCM.0b013e318246b83a
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/25701
    PubMed ID
    22610176
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1097/CCM.0b013e318246b83a
    Scopus Count
    Collections
    Morningside GSBS Scholarly Publications
    UMass Chan Faculty and Researcher Publications
    Emergency Medicine Publications

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