The life-threatening condition sepsis occurs when an infection triggers a chain reaction throughout the body. Inflammation can lead to blood clots and leaking blood vessels, and can ultimately cause organ damage or organ failure. About 1.7 million adults develop sepsis every year in the United States, and more than 250,000 of them die. Sepsis is easy to miss because symptoms such as fever and confusion are also common in other conditions, according to Suchi Saria, founding research director of the Malone Center for Engineering in Healthcare at Johns Hopkins. The faster it's caught, the better a patient's chances for survival.
Cause for Celebration
A new artificial intelligence system developed at Johns Hopkins University catches symptoms hours earlier than traditional methods, making patients 20% less likely to die from sepsis.
The system scours electronic medical records and clinical notes to identify patients at risk of life-threatening complications. The work, which could significantly cut patient mortality from one of the top causes of hospital deaths worldwide, was published in July in Nature Medicine and Nature Digital Medicine.
"It is the first instance where AI is implemented at the bedside, used by thousands of providers, and where we're seeing lives saved," says Saria, lead author of the studies, which evaluated more than a half million patients over two years. "This is an extraordinary leap that will save thousands of sepsis patients annually."
Early Warning
The Targeted Real-Time Early Warning System developed by Saria and other Johns Hopkins researchers combines a patient's medical history with current symptoms and lab results to determine when someone is at risk for sepsis and then suggest treatment protocols, such as starting antibiotics.
The machine-learning system tracks patients from the time they arrive in the hospital through discharge, ensuring that critical information isn't overlooked even if staff changes or a patient moves to a different department. Bayesian Health, a company spun off from Johns Hopkins, led and managed the deployment across testing sites.
During the study, more than 4,000 clinicians from five hospitals used the AI in treating 590,000 patients. The system also reviewed 173,931 previous patient cases.
In 82% of sepsis cases, the AI was accurate nearly 40% of the time. Previous attempts to use electronic tools to detect sepsis caught less than half that many cases and were accurate 2% to 5% of the time. And unlike conventional approaches, the system allows doctors to see why the tool is making specific recommendations.
In the most severe sepsis cases, where an hour delay is the difference between life and death, the AI detected it an average of nearly six hours earlier than traditional methods.
"This is a breakthrough in many ways," says co-author Albert Wu, an internist and director of the Johns Hopkins Center for Health Services and Outcomes Research. "Up to this point, most of these types of systems have guessed wrong much more often than they get it right. Those false alarms undermine confidence."
Expansion Plans
The team partnered with the two largest electronic health record system providers, Epic and Cerner, to ensure that the tool can be implemented at other hospitals.
And they've adapted the technology to identify patients at risk for pressure injuries—commonly known as bed sores—and those at risk for sudden deterioration caused by bleeding, acute respiratory failure, and cardiac arrest.
"The approach used here is foundationally different," Saria says. "It's adaptive and takes into consideration the diversity of the patient population, the unique ways in which doctors and nurses deliver care across different sites, and the unique characteristics of each health system, allowing it to be significantly more accurate and to gain provider trust and adoption."
Posted in Science+Technology
