Importance Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness. Objective To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients. Design, Setting, and Participants In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021. Intervention An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening. Main Outcomes and Measures The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile. Results Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile. Conclusions and Relevance Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality. Trial Registration ClinicalTrials.gov Identifier: NCT04078594.

中文翻译：

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医院病房收治患者的电子脓毒症筛查：一项阶梯楔形整群随机试验。


重要性 建议住院患者进行脓毒症筛查，但有效性证据有限。目的 评价电子脓毒症筛查与无筛查相比对住院病房患者死亡率的影响。设计、设置和参与者在沙特阿拉伯 5 家医院进行的一项阶梯式楔形整群随机试验中，将 45 个病房（集群）随机分为 9 个序列，每个序列 5 个病房，在 2 个月时实施脓毒症筛查。该研究于 2019 年 10 月 1 日至 2021 年 7 月 31 日进行，随访至 2021 年 10 月 29 日。干预 基于快速序贯器官衰竭评估评分的电子警报以静默模式在电子病历中实施，该模式被激活为脓毒症筛查的显示模式。主要结局和测量 主要结局是 90 天的院内死亡率。有 11 个次要结局，包括蓝色代码激活、血管加压药治疗、新发肾替代治疗、多重耐药微生物和艰难梭菌。结果 60 055例患者中，筛查组29 442例，无筛查组30 613例。他们的中位年龄为 59 岁 （IQR，39-68），其中男性 30 596 人 （51.0%）。筛查组 29 442 例患者中有 4299 例 （14.6%） 发生警报，无筛查组 30 613 例患者中有 5394 例 （17.6%） 发生警报。在警报后 12 小时内，与未筛查组相比，筛查组患者更有可能进行血清乳酸检测 （调整后的相对风险 [aRR]，1.30;95% CI，1.16-1.45）和静脉输液 （aRR，2.17;95% CI，1.92-2.46）。在主要结果分析中，电子筛查导致较低的 90 天院内死亡率 （aRR， 0.85;95% CI，0.77-0.93;P < .001）.筛查减少了血管加压药治疗和多重耐药微生物，但增加了蓝色代码激活、发生肾脏替代治疗和艰难梭菌。结论和相关性 在住院病房患者中，电子脓毒症筛查与无筛查相比，住院 90 d 死亡率显著降低。试验注册 ClinicalTrials.gov 标识符： NCT04078594.