Original article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781307 https://jamanetwork.com/journals/jamainternalmedicine/fullar... Not

Original article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781307 https://jamanetwork.com/journals/jamainternalmedicine/fullar... Not that "Epic" is the name of an Electronic Health Record system that embeds this proprietary algorithm for detecting sepsis. Key Points Question How accurately does the Epic Sepsis Model, a proprietary sepsis prediction model implemented at hundreds of US hospitals, predict the onset of sepsis? Findings In this cohort study of 27 697 patients undergoing 38 455 hospitalizations, sepsis occurred in 7% of the hosptalizations. The Epic Sepsis Model predicted the onset of sepsis with an area under the curve of 0.63, which is substantially worse than the performance reported by its developer. Meaning This study suggests that the Epic Sepsis Model poorly predicts sepsis; its widespread adoption despite poor performance raises fundamental concerns about sepsis management on a national level. Results We identified 27 697 patients who had 38 455 hospitalizations (21 904 women [57%]; median age, 56 years [interquartile range, 35-69 years]) meeting inclusion criteria, of whom sepsis occurred in 2552 (7%). The ESM had a hospitalization-level area under the receiver operating characteristic curve of 0.63 (95% CI, 0.62-0.64). The ESM identified 183 of 2552 patients with sepsis (7%) who did not receive timely administration of antibiotics, highlighting the low sensitivity of the ESM in comparison with contemporary clinical practice. The ESM also did not identify 1709 patients with sepsis (67%) despite generating alerts for an ESM score of 6 or higher for 6971 of all 38 455 hospitalized patients (18%), thus creating a large burden of alert fatigue. Conclusions and Relevance This external validation cohort study suggests that the ESM has poor discrimination and calibration in predicting the onset of sepsis. The widespread adoption of the ESM despite its poor performance raises fundamental concerns about sepsis management on a national level.