Pediatric Emergency Department Sepsis Screening Tool Accuracy During the COVID-19 Pandemic

Automated sepsis alerts in pediatric emergency departments (EDs) can identify patients at risk of sepsis, allowing for earlier intervention with appropriate therapies. The impact of the COVID-19 pandemic on the performance of pediatric sepsis alerts is unknown. We performed a retrospective cohort study of 59,335 ED visits prior to the pandemic and 51,990 ED visits during the pandemic in an ED with an automated sepsis alert based on systemic inflammatory response syndrome criteria. The sensitivity, specificity, negative predictive value, and positive predictive value of the sepsis algorithm was compared between the pre-pandemic and pandemic phases, and between COVID-19 negative and positive patients during the pandemic phase. The proportion of ED visits triggering a sepsis alert was 7.0% (n=4,180) prior to and 6.1% (n=3,199) during the pandemic. The number of sepsis alerts triggered per diagnosed case of hypotensive septic shock was 24 in both time periods. There was no difference in the sensitivity (74.1% vs. 72.5%), specificity (93.2% vs. 94.0%), positive predictive value (4.1% vs. 4.1%), or negative predictive value (99.9% vs. 99.9%) of the sepsis alerts between these time periods. The alerts had a lower sensitivity (60% vs. 73.3%) and specificity (87.3% vs. 94.2%) for COVID-19 positive vs. negative patients. The sepsis alert algorithm evaluated in this study did not result in excess notifications and maintained adequate performance during the COVID-19 pandemic in the pediatric ED setting.