Alicia M Alcamo, Andrew E Becker, Gregory J Barren, Katie Hayes, Jeffrey W Pennington, Martha A Q Curley, Robert C Tasker, Fran Balamuth, Scott L Weiss, Julie C Fitzgerald, Alexis A Topjian
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We tested whether the CP ABD has better diagnostic performance to identify confirmed ABD than other definitions using the Glasgow Coma Scale or delirium scores.</p><p><strong>Design: </strong>Diagnostic testing in a curated cohort of pediatric sepsis/septic shock patients.</p><p><strong>Setting: </strong>Quaternary freestanding children's hospital.</p><p><strong>Subjects: </strong>The test dataset comprised 527 children with sepsis/septic shock managed between 2011 and 2021 with a prevalence (pretest probability) of confirmed ABD of 30% (159/527).</p><p><strong>Measurements and main results: </strong>CP ABD was based on use of neuroimaging, electroencephalogram, and/or administration of new antipsychotic medication. We compared the performance of the CP ABD with three GCS/delirium-based definitions of ABD-Proulx et al, International Pediatric Sepsis Consensus Conference, and Pediatric Organ Dysfunction Information Update Mandate. The posttest probability of identifying ABD was highest in CP ABD (0.84) compared with other definitions. CP ABD also had the highest sensitivity (83%; 95% CI, 76-89%) and specificity (93%; 95% CI, 90-96%). The false discovery rate was lowest in CP ABD (1-in-6) as was the false omission rate (1-in-14). Finally, the prevalence threshold for the definitions varied, with the CP ABD being the definition closest to 20%.</p><p><strong>Conclusions: </strong>In our curated dataset of pediatric sepsis/septic shock, CP ABD had favorable characteristics to identify confirmed ABD compared with GCS/delirium-based definitions. The CP ABD can be used to further study the impact of ABD in studies using large electronic health datasets.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"740-747"},"PeriodicalIF":4.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300159/pdf/","citationCount":"0","resultStr":"{\"title\":\"Diagnostic Identification of Acute Brain Dysfunction in Pediatric Sepsis and Septic Shock in the Electronic Health Record: A Comparison of Four Definitions in a Reference Dataset.\",\"authors\":\"Alicia M Alcamo, Andrew E Becker, Gregory J Barren, Katie Hayes, Jeffrey W Pennington, Martha A Q Curley, Robert C Tasker, Fran Balamuth, Scott L Weiss, Julie C Fitzgerald, Alexis A Topjian\",\"doi\":\"10.1097/PCC.0000000000003529\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Acute brain dysfunction (ABD) in pediatric sepsis has a prevalence of 20%, but can be difficult to identify. Our previously validated ABD computational phenotype (CP ABD ) used variables obtained from the electronic health record indicative of clinician concern for acute neurologic or behavioral change. We tested whether the CP ABD has better diagnostic performance to identify confirmed ABD than other definitions using the Glasgow Coma Scale or delirium scores.</p><p><strong>Design: </strong>Diagnostic testing in a curated cohort of pediatric sepsis/septic shock patients.</p><p><strong>Setting: </strong>Quaternary freestanding children's hospital.</p><p><strong>Subjects: </strong>The test dataset comprised 527 children with sepsis/septic shock managed between 2011 and 2021 with a prevalence (pretest probability) of confirmed ABD of 30% (159/527).</p><p><strong>Measurements and main results: </strong>CP ABD was based on use of neuroimaging, electroencephalogram, and/or administration of new antipsychotic medication. We compared the performance of the CP ABD with three GCS/delirium-based definitions of ABD-Proulx et al, International Pediatric Sepsis Consensus Conference, and Pediatric Organ Dysfunction Information Update Mandate. The posttest probability of identifying ABD was highest in CP ABD (0.84) compared with other definitions. CP ABD also had the highest sensitivity (83%; 95% CI, 76-89%) and specificity (93%; 95% CI, 90-96%). The false discovery rate was lowest in CP ABD (1-in-6) as was the false omission rate (1-in-14). Finally, the prevalence threshold for the definitions varied, with the CP ABD being the definition closest to 20%.</p><p><strong>Conclusions: </strong>In our curated dataset of pediatric sepsis/septic shock, CP ABD had favorable characteristics to identify confirmed ABD compared with GCS/delirium-based definitions. 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引用次数: 0
摘要
目的：小儿败血症急性脑功能障碍（ABD）的发病率为 20%，但很难识别。我们之前验证的急性脑功能障碍计算表型（CPABD）使用了从电子健康记录中获取的变量，这些变量表明临床医生对急性神经或行为变化的关注。我们测试了 CPABD 在识别确诊 ABD 方面的诊断性能是否优于使用格拉斯哥昏迷量表或谵妄评分的其他定义：设计：对小儿败血症/败血症休克患者进行诊断测试：环境：四级独立儿童医院：测试数据集包括2011年至2021年间接受治疗的527名脓毒症/败血症休克患儿，确诊ABD的患病率（测试前概率）为30%（159/527）：CPABD基于神经影像学、脑电图和/或新抗精神病药物的使用。我们比较了 CPABD 与三种基于 GCS/谵妄的 ABD 定义--Proulx 等人、国际儿科败血症共识会议和儿科器官功能障碍信息更新规定--的性能。与其他定义相比，CPABD 确定 ABD 的检验后概率最高（0.84）。CPABD 的灵敏度（83%；95% CI，76-89%）和特异性（93%；95% CI，90-96%）也最高。CPABD 的错误发现率最低（1/6），错误遗漏率也最低（1/14）。最后，各种定义的患病率阈值各不相同，其中 CPABD 是最接近 20% 的定义：结论：在我们整理的小儿败血症/败血症休克数据集中，与基于 GCS/谵妄的定义相比，CPABD 在识别确诊 ABD 方面具有良好的特性。CPABD 可用于在使用大型电子健康数据集的研究中进一步研究 ABD 的影响。
Diagnostic Identification of Acute Brain Dysfunction in Pediatric Sepsis and Septic Shock in the Electronic Health Record: A Comparison of Four Definitions in a Reference Dataset.
Objectives: Acute brain dysfunction (ABD) in pediatric sepsis has a prevalence of 20%, but can be difficult to identify. Our previously validated ABD computational phenotype (CP ABD ) used variables obtained from the electronic health record indicative of clinician concern for acute neurologic or behavioral change. We tested whether the CP ABD has better diagnostic performance to identify confirmed ABD than other definitions using the Glasgow Coma Scale or delirium scores.
Design: Diagnostic testing in a curated cohort of pediatric sepsis/septic shock patients.
Subjects: The test dataset comprised 527 children with sepsis/septic shock managed between 2011 and 2021 with a prevalence (pretest probability) of confirmed ABD of 30% (159/527).
Measurements and main results: CP ABD was based on use of neuroimaging, electroencephalogram, and/or administration of new antipsychotic medication. We compared the performance of the CP ABD with three GCS/delirium-based definitions of ABD-Proulx et al, International Pediatric Sepsis Consensus Conference, and Pediatric Organ Dysfunction Information Update Mandate. The posttest probability of identifying ABD was highest in CP ABD (0.84) compared with other definitions. CP ABD also had the highest sensitivity (83%; 95% CI, 76-89%) and specificity (93%; 95% CI, 90-96%). The false discovery rate was lowest in CP ABD (1-in-6) as was the false omission rate (1-in-14). Finally, the prevalence threshold for the definitions varied, with the CP ABD being the definition closest to 20%.
Conclusions: In our curated dataset of pediatric sepsis/septic shock, CP ABD had favorable characteristics to identify confirmed ABD compared with GCS/delirium-based definitions. The CP ABD can be used to further study the impact of ABD in studies using large electronic health datasets.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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