7 ms·

The issue is that sepsis is very poorly defined, difficult to distinguish from other conditions, and very serious if missed. This means that I get automated ale

The issue is that sepsis is very poorly defined, difficult to distinguish from other conditions, and very serious if missed. This means that I get automated alerts for patients all day querying sepsis, but probably only 5% (maybe fewer) have any signs of infection clinically. This reflects clinical practice where we overtreat initially and then row back treatment if things improve. I can go for a run on a hot day- I'll be pyrexic, tachypnoeic, and tachycardic- enough to trigger a sepsis alert. Whereas an elderly patient who is a bit more confused than normal may have a very severe raging infection with few changes in their markers.

mjburgess 5y ago
It seems like this should be a sepsis-risk calculation then, based on extrinsic factors (age, admittance reason, etc.); rather than intrinsic factors (hr, bp..). The problem here then, i'd guess, is how many of those extrinsic factors are unmeasurable in practice; and how little data we'd have on them.
- joshgel 5y ago
  Basically everyone admitted to the hospital is at some level or risk from sepsis which is why the proxy markers become important.
- stuartbman 5y ago
  Sure, and there's a lot of work in this area to predict sepsis in specific subgroups, but as with a lot of AI I think we're a long, long way off a 'general purpose' sepsis detector. For various reasons sepsis just presents differently in different patient groups so one person's risk factor is another's protective factor
joshgel 5y ago
Sepsis is pretty well defined between SIRS and qSOFA. But the definition has a subjective component which has very poor inter-rater reliability. And you’re 100% right that the definition overlaps with other very common conditions, such as pain or having just had an operation.
epmaybe 5y ago
I have this conversation with my attendings regularly regarding scaling back treatment. Everyone has their own comfort level with how aggressive they are doing that, and it would be interesting to see better heuristics that would allow for more appropriate de-escalation sooner (or longer, I guess)
cratermoon 5y ago
Hot, breathing heard, with a fast heartbeat. For the laypeople out there. Saved you three lookups. Just call me the human memoizer.
- SQueeeeeL 5y ago
  I'm gonna call you the "being decent at communicating"izer, for using commonly understandable terms and not ego stroking about how much medical vocab you know

mjburgess 5y ago

It seems like this should be a sepsis-risk calculation then, based on extrinsic factors (age, admittance reason, etc.); rather than intrinsic factors (hr, bp..). The problem here then, i'd guess, is how many of those extrinsic factors are unmeasurable in practice; and how little data we'd have on them.

joshgel 5y ago
Basically everyone admitted to the hospital is at some level or risk from sepsis which is why the proxy markers become important.
stuartbman 5y ago
Sure, and there's a lot of work in this area to predict sepsis in specific subgroups, but as with a lot of AI I think we're a long, long way off a 'general purpose' sepsis detector. For various reasons sepsis just presents differently in different patient groups so one person's risk factor is another's protective factor

joshgel 5y ago

Sepsis is pretty well defined between SIRS and qSOFA. But the definition has a subjective component which has very poor inter-rater reliability. And you’re 100% right that the definition overlaps with other very common conditions, such as pain or having just had an operation.

epmaybe 5y ago

I have this conversation with my attendings regularly regarding scaling back treatment. Everyone has their own comfort level with how aggressive they are doing that, and it would be interesting to see better heuristics that would allow for more appropriate de-escalation sooner (or longer, I guess)

cratermoon 5y ago

Hot, breathing heard, with a fast heartbeat. For the laypeople out there. Saved you three lookups. Just call me the human memoizer.

SQueeeeeL 5y ago
I'm gonna call you the "being decent at communicating"izer, for using commonly understandable terms and not ego stroking about how much medical vocab you know