Digital alerting and outcomes in patients With sepsis: systematic review and meta-analysis (Preprint)
Author(s)
Type
Working Paper
Abstract
Background:
The diagnosis and management of sepsis remains a global healthcare challenge. Digital technologies are beginning to transform healthcare and have the potential to improve the identification of sepsis.
Objective:
This paper systematically reviews the evidence on the impact of digital alerting systems on sepsis related outcomes.
Methods:
Study Selection Embase, Medline, HMIC, Psych Info and Cochrane were searched from April 1964 to 12th February 2019 with no language restriction. All full text reports of studies identified as potentially eligible after title and abstract review were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand-searched for remaining studies. Only studies with clear pre-and post-alerting phases were included. Primary outcomes were hospital length of stay (LOS) and intensive care LOS, secondary outcomes were time to antibiotics and mortality. Studies based solely on intensive care, case reports, narrative reviews, editorials and commentaries were excluded.
Results:
This review identified 72 full text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital length of stay, 11 mortality outcomes, 5 studies explored time to antibiotics, 5 studies investigated ICU length of stay. A qualitative assessment of all studies was performed. There was evidence of a significant benefit of digital altering on hospital length of stay, reduced by 1.31 days(p=0.014), and ICU length of stay, reduced by 0.766 days(p=0.007). There was no significant difference association between digital alerts and mortality (mean decrease 11.4%,p=0.769) or time to antibiotics (mean decrease 126 minutes, p=0.134).
Conclusions:
This review highlights that digital alerts can significantly reduce hospital and ICU stay. Further studies including more randomized control trials are necessary to confirm these findings as well as identify the choice of alerting system according to patient status and pathological cohort.
The diagnosis and management of sepsis remains a global healthcare challenge. Digital technologies are beginning to transform healthcare and have the potential to improve the identification of sepsis.
Objective:
This paper systematically reviews the evidence on the impact of digital alerting systems on sepsis related outcomes.
Methods:
Study Selection Embase, Medline, HMIC, Psych Info and Cochrane were searched from April 1964 to 12th February 2019 with no language restriction. All full text reports of studies identified as potentially eligible after title and abstract review were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand-searched for remaining studies. Only studies with clear pre-and post-alerting phases were included. Primary outcomes were hospital length of stay (LOS) and intensive care LOS, secondary outcomes were time to antibiotics and mortality. Studies based solely on intensive care, case reports, narrative reviews, editorials and commentaries were excluded.
Results:
This review identified 72 full text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital length of stay, 11 mortality outcomes, 5 studies explored time to antibiotics, 5 studies investigated ICU length of stay. A qualitative assessment of all studies was performed. There was evidence of a significant benefit of digital altering on hospital length of stay, reduced by 1.31 days(p=0.014), and ICU length of stay, reduced by 0.766 days(p=0.007). There was no significant difference association between digital alerts and mortality (mean decrease 11.4%,p=0.769) or time to antibiotics (mean decrease 126 minutes, p=0.134).
Conclusions:
This review highlights that digital alerts can significantly reduce hospital and ICU stay. Further studies including more randomized control trials are necessary to confirm these findings as well as identify the choice of alerting system according to patient status and pathological cohort.
Date Issued
2019-06-28
Citation
2019
Publisher
JMIR Publications Inc.
Copyright Statement
© 2018 The Author(s).
Sponsor
National Institute for Health Research
Identifier
https://preprints.jmir.org/preprint/15166/submitted
Grant Number
NF SI 061710038
Publication Status
Published