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A surveillance method to identify patients with sepsis from electronic health records in Hong Kong: a single centre retrospective study.

ABSTRACT: BACKGROUND:Currently there are only two population studies on sepsis incidence in Asia. The burden of sepsis in Hong Kong is unknown. We developed a sepsis surveillance method to estimate sepsis incidence from a population electronic health record (EHR) in Hong Kong using objective clinical data. The study objective was to assess our method's performance in identifying sepsis using a retrospective cohort. We compared its accuracy to administrative sepsis surveillance methods such as Angus' and Martin's methods. METHOD:In this single centre retrospective study we applied our sepsis surveillance method on adult patients admitted to a tertiary hospital in Hong Kong. Two clinicians independently reviewed the clinical notes to determine which patients had sepsis. Performance was assessed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of Angus', Martin's and our surveillance methods using clinical review as "gold standard." RESULTS:Between January 1 and February 28, 2018, our sepsis surveillance method identified 1352 adult patients hospitalised with suspected infection. We found that 38.9% (95%CI 36.3-41.5) of these patients had sepsis. Using a 490 patient validation cohort, two clinicians had good agreement with weighted kappa of 0.75 (95% CI 0.69-0.81) before coming to consensus on diagnosis of uncomplicated infection or sepsis for all patients. Our method had sensitivity 0.93 (95%CI 0.89-0.96), specificity 0.86 (95%CI 0.82-0.90) and an AUC 0.90 (95%CI 0.87-0.92) when validated against clinician review. In contrast, Angus' and Martin's methods had AUCs 0.56 (95%CI 0.53-0.58) and 0.56 (95%CI 0.52-0.59), respectively. CONCLUSIONS:A sepsis surveillance method based on objective data from a population EHR in Hong Kong was more accurate than administrative methods. It may be used to estimate sepsis population incidence and outcomes in Hong Kong. TRIAL REGISTRATION:This study was retrospectively registered at clinicaltrials.gov on October 3, 2019 ( NCT04114214 ).

SUBMITTER: Liu YZ

PROVIDER: S-EPMC7487694 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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A surveillance method to identify patients with sepsis from electronic health records in Hong Kong: a single centre retrospective study.

Liu Ying Zhi YZ Chu Raymond R Lee Anna A Gomersall Charles David CD Zhang Lin L Gin Tony T Chan Matthew T V MTV Wu William K K WKK Ling Lowell L

BMC infectious diseases 20200907 1

<h4>Background</h4>Currently there are only two population studies on sepsis incidence in Asia. The burden of sepsis in Hong Kong is unknown. We developed a sepsis surveillance method to estimate sepsis incidence from a population electronic health record (EHR) in Hong Kong using objective clinical data. The study objective was to assess our method's performance in identifying sepsis using a retrospective cohort. We compared its accuracy to administrative sepsis surveillance methods such as Angu ...[more]

PMID: 32894059

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Project description:BackgroundConsultation rates of influenza-like illness (ILI) in an outpatient setting have been regarded as a good indicator of influenza virus activity in the community. As ILI-like symptoms may be caused by etiologies other than influenza, and influenza virus activity in the tropics and subtropics is less predictable than in temperate regions, the correlation between of ILI and influenza virus activity in tropical and subtropical regions is less well defined.Methodology and principal findingsIn this study, we used wavelet analysis to investigate the relationship between seasonality of influenza virus activity and consultation rates of ILI reported separately by General Out-patient Clinics (GOPC) and General Practitioners (GP). During the periods 1998-2000 and 2002-2003, influenza virus activity exhibited both annual and semiannual cycles, with one peak in the winter and another in late spring or early summer. But during 2001 and 2004-2006, only annual cycles could be clearly identified. ILI consultation rates in both GOPC and GP settings share a similar non-stationary seasonal pattern. We found high coherence between ILI in GOPC and influenza virus activity for the annual cycle, but this was only significant (p<0.05) during the periods 1998-1999 and 2002-2006. For the semiannual cycle high coherence (p<0.05) was also found significant during the period 1998-1999 and year 2003 when two peaks of influenza were evident. Similarly, ILI in GP setting is also associated with influenza virus activity for both the annual and semiannual cycles. On average, oscillation of ILI in GP and of ILI in GOPC preceded influenza virus isolation by approximately four and two weeks, respectively.ConclusionsOur findings suggest that consultation rates of ILI precede the oscillations of laboratory surveillance by at least two weeks and can be used as a predictor for influenza epidemics in Hong Kong. The validity of our model for other tropical regions needs to be explored.

Project description:BackgroundWith the advancement of technology, more countries are now adopting the use of electronic product information (ePI), which refer to an electronic version of physical product inserts in a semistructured format optimized for electronic manipulation. The successful implementation of ePI has led to advantages and convenience to patients, health care professionals, and pharmaceutical companies in many regions and countries. In the Hong Kong Special Administrative Region (SAR), there is currently no citywide implementation of ePI. The SAR exhibits conditions that would favor the implementation of an ePI system, as well as existing barriers hindering its implementation. However, no study has been performed to examine the specific situation in Hong Kong.ObjectiveThe objective of this study is to explore working pharmacists' overall perception of ePI and to identify potential challenges to the implementation of an ePI system in Hong Kong.MethodsThis mixed-method study involved a structured survey and interview with practicing pharmacists in Hong Kong. Pharmacists were eligible if they were licensed to practice in Hong Kong, and currently working locally in any pharmacy-related sectors and institutions. Respondents completed a survey to indicate their level of agreement with statements regarding the potential advantages of ePI over paper PI. A structured interview was conducted to gather respondents' perceived advantages of ePI over paper PI in different aspects, such as professionalism, usability, presentation, and environment, as well as challenges of citywide ePI implementation in Hong Kong. Thematic analysis was adopted to analyze the qualitative data. Grounded theory was used to generate themes and identify specific outcomes.ResultsA total of 16 pharmacists were recruited, comprising 4 community pharmacists, 5 hospital pharmacists, and 7 industrial pharmacists. All of them used electronic platforms at least once per month on average. Respondents identified many flaws in physical package inserts that can potentially be mitigated using ePI. The speed with which drug information can be retrieved and the degree to which the drug information can be readily updated and disseminated were considered the greatest strengths of ePI. The clarity with which ePI present drug information to patients was considered as the weakest aspect of ePI. Many respondents highlighted concerns about the security risks and high cost associated with system maintenance and that certain subpopulations may not be sufficiently computer literate to navigate the ePI system. Respondents also voiced many concerns about the implementation and maintenance of a local ePI system.ConclusionsWe conclude that an ePI system is generally supported by pharmacists but concerns about implementation process and maintenance of the system has been raised. The perceived benefits of ePI gathered from this study, as well as collective evidence from other countries with mature ePI systems, confirm that more efforts should be made to promote optimized development and implementation of an ePI system in Hong Kong.

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Project description:BackgroundInfectious disease surveillance is a process the product of which reflects both actual disease trends and public awareness of the disease. Decisions made by patients, health care providers, and public health professionals about seeking and providing health care and about reporting cases to health authorities are all influenced by the information environment, which changes constantly. Biases are therefore imbedded in surveillance systems; these biases need to be characterized to provide better situational awareness for decision-making purposes. Our goal is to develop a statistical framework to characterize influenza surveillance systems, particularly their correlation with the information environment.MethodsWe identified Hong Kong influenza surveillance data systems covering healthcare providers, laboratories, daycare centers and residential care homes for the elderly. A Bayesian hierarchical statistical model was developed to examine the statistical relationships between the influenza surveillance data and the information environment represented by alerts from HealthMap and web queries from Google. Different models were fitted for non-pandemic and pandemic periods and model goodness-of-fit was assessed using common model selection procedures.ResultsSome surveillance systems - especially ad hoc systems developed in response to the pandemic flu outbreak - are more correlated with the information environment than others. General practitioner (percentage of influenza-like-illness related patient visits among all patient visits) and laboratory (percentage of specimen tested positive) seem to proportionally reflect the actual disease trends and are less representative of the information environment. Surveillance systems using influenza-specific code for reporting tend to reflect biases of both healthcare seekers and providers.ConclusionsThis study shows certain influenza surveillance systems are less correlated with the information environment than others, and therefore, might represent more reliable indicators of disease activity in future outbreaks. Although the patterns identified in this study might change in future outbreaks, the potential susceptibility of surveillance data is likely to persist in the future, and should be considered when interpreting surveillance data.

Dataset Information

A surveillance method to identify patients with sepsis from electronic health records in Hong Kong: a single centre retrospective study.

Publications

A surveillance method to identify patients with sepsis from electronic health records in Hong Kong: a single centre retrospective study.

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