Performance Characteristics of Sepsis Screening Tools During Delivery Admissions

Authors

Elliott K Main
Matt Fuller
Vesela P Kovacheva
Rania Elkhateb
Kristen Azar
Morgan Caldwell
Vanna Chiem
Mindy Foster
Ronald Gibbs
Brenna L Hughes
Rebecca Johnson
Nobin Kottukapally
Magdalena Sanz Cortes
Melissa G Rosenstein
Laurence E Shields
Sylvia Sudat
Caitlin D Sutton
Paloma Toledo
Austin Traylor
Kurt Wharton
Melissa E Bauer

Language

English

Publication Date

3-1-2024

Journal

Obstetrics & Gynecology

DOI

10.1097/AOG.0000000000005477

PMID

38086055

PMCID

PMC10922218

PubMedCentral® Posted Date

3-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Objective: To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions.

Methods: This was a case-control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis-endometritis, and cohort 2, which included those patients.

Results: Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis-endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis-endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC.

Conclusion: During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. Performance of all screening tools was degraded in the setting of chorioamnionitis-endometritis.

Keywords

Pregnancy, Female, Humans, Chorioamnionitis, Case-Control Studies, Retrospective Studies, Endometritis, Sepsis, Systemic Inflammatory Response Syndrome

Published Open-Access

yes

Recommended Citation

Main, Elliott K; Fuller, Matt; Kovacheva, Vesela P; et al., "Performance Characteristics of Sepsis Screening Tools During Delivery Admissions" (2024). Faculty and Staff Publications. 5444.
https://digitalcommons.library.tmc.edu/baylor_docs/5444