Impact of a deep learning sepsis prediction model on quality of care and survival

• Published in: NPJ digital medicine 2024-01, Vol.7 (1), p.14-9, Article 14
• Main Authors: Boussina, Aaron, Shashikumar, Supreeth P., Malhotra, Atul, Owens, Robert L., El-Kareh, Robert, Longhurst, Christopher A., Quintero, Kimberly, Donahue, Allison, Chan, Theodore C., Nemati, Shamim, Wardi, Gabriel
• Format: Article
• Language: English
• Subjects: 692/700/1750; 692/700/459/1748; Biomedicine; Biotechnology; Clinical outcomes; Deep learning; Digital technology; Medicine; Medicine & Public Health; Mortality; Qualitative research; Sepsis
• ISSN: 2398-6352; 2398-6352
• DOI: 10.1038/s41746-023-00986-6

Sepsis remains a major cause of mortality and morbidity worldwide. Algorithms that assist with the early recognition of sepsis may improve outcomes, but relatively few studies have examined their impact on real-world patient outcomes. Our objective was to assess the impact of a deep-learning model (COMPOSER) for the early prediction of sepsis on patient outcomes. We completed a before-and-after quasi-experimental study at two distinct Emergency Departments (EDs) within the UC San Diego Health System. We included 6217 adult septic patients from 1/1/2021 through 4/30/2023. The exposure tested was a nurse-facing Best Practice Advisory (BPA) triggered by COMPOSER. In-hospital mortality, sepsis bundle compliance, 72-h change in sequential organ failure assessment (SOFA) score following sepsis onset, ICU-free days, and the number of ICU encounters were evaluated in the pre-intervention period (705 days) and the post-intervention period (145 days). The causal impact analysis was performed using a Bayesian structural time-series approach with confounder adjustments to assess the significance of the exposure at the 95% confidence level. The deployment of COMPOSER was significantly associated with a 1.9% absolute reduction (17% relative decrease) in in-hospital sepsis mortality (95% CI, 0.3%–3.5%), a 5.0% absolute increase (10% relative increase) in sepsis bundle compliance (95% CI, 2.4%–8.0%), and a 4% (95% CI, 1.1%–7.1%) reduction in 72-h SOFA change after sepsis onset in causal inference analysis. This study suggests that the deployment of COMPOSER for early prediction of sepsis was associated with a significant reduction in mortality and a significant increase in sepsis bundle compliance.