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June 21, 2021

The Epic Sepsis Model Falls Short—The Importance of External Validation

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Editorial Fellow, JAMA Internal Medicine
  • 3Division of Research, Kaiser Permanente Northern California, Oakland
  • 4Associate Editor, JAMA Internal Medicine
JAMA Intern Med. 2021;181(8):1040-1041. doi:10.1001/jamainternmed.2021.3333

Sepsis accounts for nearly 1 million hospitalizations annually and is a major contributor to hospital length of stay, health care expenditures, and in-hospital mortality (ranging from 12.5%-15%).1 Early sepsis identification allows care teams to promptly implement goal-directed therapy to mitigate clinical deterioration. In this issue of JAMA Internal Medicine, Wong et al2 report on their external validation of the Epic Sepsis Model (ESM), a prediction tool available within the Epic electronic health record that is designed to generate automated alerts that warn clinicians that patients may be developing sepsis. Based on their examination of 38 455 hospitalizations at the University of Michigan (Ann Arbor) between December 2018 and October 2019, Wong et al2 found that the ESM had a sensitivity of 33%, specificity of 83%, positive predictive value of 12%, and negative predictive value of 95%, with an area under the curve of 0.63 (95% CI, 0.62-0.64). This falls short of the area under the curve of 0.76 to 0.83 that was jointly reported by Epic and University of Colorado Health.3 Despite generating alerts on 18% of all patients, the ESM did not detect sepsis in 67% of patients with sepsis.

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