Pediatrics_Sirs2 v.1

This GDL is a rule-based program that creates CDS notifications/alerts for recognition of critical illness in patients of all ages. The design uses current critical illness (including sepsis) identification approaches specific to pediatric and adult medicine, respectively. This makes the tool useful for all age patients, as an application valid across the entire age range from 0-100+yrs. The inputs are common vital signs and laboratory data. The abnormal ranges and rules applied are determined by specific, appropriate ranges of age, and provided by current research and practice.

Nathan Brown

nathanpatrickbrown@gmail.com

Reserved

Vital signs and lab abnormals vary depending by patient age. The GDL is intended to assist recognition of critical illness in all ages; it applies clinically age-appropriate rules on data that represents common vital signs and laboratory data found in an EHR. Specifically, it collects input Heart Rate, Respiratory Rate, Systolic Blood Pressure, White Blood Cell Count, and Temperature, as well as the patient Date of Birth. Date of Birth allows age-specific vital sign ranges and CDS Alerts to be generated, including alerts such Pediatric modified SIRS, Adult SIRS, qSOFA and Shock Index. These may be helpful in recognition of Sepsis, as well as additional critical disease states.

The tool is intended for pilot use in the process of development of future EHR-based CDS apps. The age-specific alert concept is applicable to multiple clinical settings, including emergency medicine, urgent care medicine, inpatient medicine, and pre-hospital medicine, settings where recognition of a critically ill patient of various different patient ages (pediatric to adult) may be required. The concept would be to apply the rules broadly in the EHR, and use alerts as a provider pop-up or as indicator icons or formating in conjunction with display of vital signs.

The concept is not intended to be used in direct to consumer apps. In a future version, the alert notifications would be based on current data extracted from an EHR, rather than entered by a web form.

Sepanski, R. J., Godambe, S. A., Mangum, C. D., Bovat, C. S., Zaritsky, A. L., & Shah, S. H. (2014). Designing a Pediatric Severe Sepsis Screening Tool. Frontiers in Pediatrics, 2, 56. http://doi.org/10.3389/fped.2014.00056 Finkelsztein, E. J., Jones, D. S., Ma, K. C., Pabón, M. A., Delgado, T., Nakahira, K., … Siempos, I. I. (2017). Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit. Critical Care, 21, 73. http://doi.org/10.1186/s13054-017-1658-5 Berger, T., Green, J., Horeczko, T., Hagar, Y., Garg, N., Suarez, A., … Shapiro, N. (2013). Shock Index and Early Recognition of Sepsis in the Emergency Department: Pilot Study. Western Journal of Emergency Medicine, 14(2), 168–174. http://doi.org/10.5811/westjem.2012.8.11546

OBSERVATION.basic_demographic_ped_sirs2.v1, OBSERVATION.pulse.v2, OBSERVATION.body_temperature.v2, OBSERVATION.blood_pressure.v2, OBSERVATION.respiration.v2, OBSERVATION.lab_test-full_blood_count.v1, OBSERVATION.vital_sign_alerts.v0, OBSERVATION.vitals_alert_details.v0, OBSERVATION.shock_index.v1